{
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"FirstLineMailingAddress": "69 ALLEN ST",
"SecondLineMailingAddress": "SUITE #5",
"MailingAddressCityName": "RUTLAND",
"MailingAddressStateName": "VT",
"MailingAddressPostalCode": "05701-4590",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "802-773-2626",
"MailingAddressFaxNumber": "802-773-5245",
"FirstLinePracticeLocationAddress": "69 ALLEN ST",
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"EnumerationDate": "01/18/2013",
"LastUpdateDate": "01/18/2013",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "STICKNEY",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Internal Medicine Physician",
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"LicenseNumberStateCode": "VT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}