{
"Npi": {
"NPI": "1790767135",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "X",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TEBROCK",
"FirstName": "MELISSA",
"MiddleName": "J",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "LANDSTUHL REGIONAL MEDICAL CENTER",
"SecondLineMailingAddress": "ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402",
"MailingAddressCityName": "APO",
"MailingAddressStateName": "AE",
"MailingAddressPostalCode": "09180",
"MailingAddressCountryCode": "DE",
"MailingAddressTelephoneNumber": "011496371868839",
"MailingAddressFaxNumber": "011496371866133",
"FirstLinePracticeLocationAddress": "LANDSTUHL REGIONAL MEDICAL CENTER",
"SecondLinePracticeLocationAddress": "FAMILY MEDICINE CLINIC, CMR 402",
"PracticeLocationAddressCityName": "APO",
"PracticeLocationAddressStateName": "AE",
"PracticeLocationAddressPostalCode": "09180",
"PracticeLocationAddressCountryCode": "DE",
"PracticeLocationAddressTelephoneNumber": "011496371866640",
"PracticeLocationAddressFaxNumber": "011496371866051",
"EnumerationDate": "11/18/2005",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "01051936A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}