{
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"ParentOrgLBN": null,
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"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2111 S TAMIAMI TRL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OSPREY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34229-9668",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-966-2900",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2111 S TAMIAMI TRL",
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"PracticeLocationAddressCityName": "OSPREY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-966-2900",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/22/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAJERCIN",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "941-966-2900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "CH7308",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}