{
"Npi": {
"NPI": "1083688923",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "X",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MUSHLIN",
"FirstName": "GENNADY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4235 CANYON TRAILS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WICHITA FALLS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76309-2705",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "940-691-9722",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "149 HART ST",
"SecondLinePracticeLocationAddress": "82 MEDICAL GROUP",
"PracticeLocationAddressCityName": "SHEPPARD AFB",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76311-3477",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "940-676-6855",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/15/2006",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "22575",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "L5066",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}