{
"Npi": {
"NPI": "1811977465",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MIRKIN",
"FirstName": "GABE",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MIRKIN",
"OtherFirstName": "GABRIEL",
"OtherMiddleName": "BARON",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1455 BRIER CREEK CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THE VILLAGES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32162-4101",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-350-6216",
"MailingAddressFaxNumber": "352-350-6216",
"FirstLinePracticeLocationAddress": "10901 CONNECTICUT AVENUE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KENSINGTON",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20895-1645",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-942-7900",
"PracticeLocationAddressFaxNumber": "301-942-9837",
"EnumerationDate": "01/19/2006",
"LastUpdateDate": "06/24/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "D0013921",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}