{
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"FirstLineMailingAddress": "45 FOREST FALLS DR",
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"MailingAddressCityName": "YARMOUTH",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04096-6999",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "45 FOREST FALLS DR",
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"PracticeLocationAddressTelephoneNumber": "207-751-3970",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/25/2020",
"LastUpdateDate": "01/20/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITE",
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"AuthorizedOfficialTitle": "AUTHORIZED OFFICIAL",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "207-888-3640",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}