{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "3D SPORTS MEDICINE AND ORTHOPAEDIC CENTER",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "2231 HAMPTON GREEN BLVD APT 105",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MELBOURNE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32935",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-250-3085",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2194 HIGHWAY A1A STE 104",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "INDIAN HARBOUR BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32937-4955",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "321-610-8939",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/20/2017",
"LastUpdateDate": "02/20/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUDNALL",
"AuthorizedOfficialFirstName": "BRANDON",
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"AuthorizedOfficialTitle": "ATHLETIC TRAINER/PHYSICIAN EXTENDER",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "LAT, ATC",
"AuthorizedOfficialTelephoneNumber": "540-250-3085",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "AL4490",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}