{
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"OrgName": "RSM PLASTIC SURGERY, PA",
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"FirstLineMailingAddress": "3300 WEST LAKE MARY BLVD",
"SecondLineMailingAddress": "SUITE 210",
"MailingAddressCityName": "LAKE MARY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32746",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-632-1010",
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"FirstLinePracticeLocationAddress": "3300 W LAKE MARY BLVD STE 210",
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"PracticeLocationAddressCityName": "LAKE MARY",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressTelephoneNumber": "863-899-9736",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/10/2018",
"LastUpdateDate": "08/21/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KING",
"AuthorizedOfficialFirstName": "KANDICE",
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"AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "847-228-3303",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208200000X",
"TaxonomyName": "Plastic Surgery Physician",
"LicenseNumber": "ME136100",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}