{
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"NamePrefix": null,
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"FirstLineMailingAddress": "1810 SIDNEY BAKER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KERRVILLE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78028-2644",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-232-2607",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "501 E HIGHWAY ST STE 100",
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"PracticeLocationAddressCityName": "FREDERICKSBURG",
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"PracticeLocationAddressTelephoneNumber": "830-307-9390",
"PracticeLocationAddressFaxNumber": "830-307-9391",
"EnumerationDate": "02/27/2018",
"LastUpdateDate": "09/19/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATEL",
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"AuthorizedOfficialTelephoneNumber": "210-232-2607",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0003X",
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
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}
}