{
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"NamePrefix": null,
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"FirstLineMailingAddress": "P.O. BOX 2188",
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"MailingAddressCityName": "CYPRESS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77410",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "713-303-3189",
"MailingAddressFaxNumber": "281-593-2928",
"FirstLinePracticeLocationAddress": "13325 HARGRAVE ROAD",
"SecondLinePracticeLocationAddress": "SUITE 230A",
"PracticeLocationAddressCityName": "HOUSTON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-888-0222",
"PracticeLocationAddressFaxNumber": "844-732-7187",
"EnumerationDate": "05/22/2017",
"LastUpdateDate": "03/11/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "10/20/2020",
"NPIReactivationDate": "02/01/2021",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
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"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialTelephoneNumber": "713-303-3189",
"Taxonomies": {
"Taxonomy": [
{
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
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}
}