{
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"EIN": null,
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"FirstLineMailingAddress": "1335 HIDE A WAY LN W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HIDEAWAY",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75771-5115",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-882-5002",
"MailingAddressFaxNumber": "903-882-5305",
"FirstLinePracticeLocationAddress": "1335 HIDE A WAY LN W",
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"PracticeLocationAddressCityName": "HIDEAWAY",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-882-5002",
"PracticeLocationAddressFaxNumber": "903-882-5305",
"EnumerationDate": "11/19/2009",
"LastUpdateDate": "11/19/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Contractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}