{
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"FirstLineMailingAddress": "PO BOX 1442",
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"MailingAddressTelephoneNumber": "985-542-8466",
"MailingAddressFaxNumber": "985-542-2561",
"FirstLinePracticeLocationAddress": "113 W CHARLES ST",
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"EnumerationDate": "07/30/2006",
"LastUpdateDate": "09/30/2016",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANNINO",
"AuthorizedOfficialFirstName": "RICHARD",
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"AuthorizedOfficialCredential": "RPH",
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{
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},
{
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},
{
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},
{
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"LicenseNumber": "PHY.001825IR",
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}
]
},
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}
}