{
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"FirstLineMailingAddress": "2327 RUBY OAKS",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78232-5600",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-823-7056",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "16601 BLANCO RD",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/10/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JENNINGS",
"AuthorizedOfficialFirstName": "WESLEY",
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"AuthorizedOfficialTelephoneNumber": "210-823-7056",
"Taxonomies": {
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"TaxonomyName": "Mobile Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}