{
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"EIN": null,
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"FirstLineMailingAddress": "1730 S FEDERAL HWY",
"SecondLineMailingAddress": "#289",
"MailingAddressCityName": "DELRAY BEACH",
"MailingAddressStateName": "FL",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "561-808-7607",
"FirstLinePracticeLocationAddress": "212 NE 1ST AVE",
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"PracticeLocationAddressCityName": "DELRAY BEACH",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-808-7581",
"PracticeLocationAddressFaxNumber": "561-808-7607",
"EnumerationDate": "06/23/2014",
"LastUpdateDate": "06/23/2014",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Adult Medicine Physician",
"LicenseNumber": "1699854562",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}