{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "RICHARD STOVALL MD PA",
"LastName": null,
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"FirstLineMailingAddress": "PO BOX 25887",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OKLAHOMA CITY",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73125-0887",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-835-8100",
"MailingAddressFaxNumber": "512-835-8101",
"FirstLinePracticeLocationAddress": "2200 PARK BEND DR",
"SecondLinePracticeLocationAddress": "BLDG 2, STE 201",
"PracticeLocationAddressCityName": "AUSTIN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78758-5388",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "512-835-8100",
"PracticeLocationAddressFaxNumber": "512-835-8101",
"EnumerationDate": "11/01/2006",
"LastUpdateDate": "10/19/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ONTIVEROS",
"AuthorizedOfficialFirstName": "MANDY",
"AuthorizedOfficialMiddleName": "LYNN",
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"AuthorizedOfficialTelephoneNumber": "512-835-8100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207T00000X",
"TaxonomyName": "Neurological Surgery Physician",
"LicenseNumber": "K5409",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}