{
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"EIN": null,
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"Credential": "M.D.",
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"OtherOrgNameTypeCode": null,
"OtherLastName": "WHITTWELL",
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"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "6705 S RED RD",
"SecondLineMailingAddress": "SUITE 416",
"MailingAddressCityName": "SOUTH MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33143-3622",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-665-0100",
"MailingAddressFaxNumber": "305-665-0149",
"FirstLinePracticeLocationAddress": "6705 S RED RD",
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"PracticeLocationAddressCityName": "SOUTH MIAMI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-665-0100",
"PracticeLocationAddressFaxNumber": "305-665-0149",
"EnumerationDate": "05/11/2006",
"LastUpdateDate": "06/30/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "ME41757",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}