{
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"FirstLineMailingAddress": "2700 W PLEASANT RUN RD",
"SecondLineMailingAddress": "360",
"MailingAddressCityName": "LANCASTER",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75146-1079",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-230-1307",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2700 W PLEASANT RUN RD",
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"PracticeLocationAddressTelephoneNumber": "972-230-1307",
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"EnumerationDate": "12/13/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GALLENTINE",
"AuthorizedOfficialFirstName": "SHANNONO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "DPM",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213EP1101X",
"TaxonomyName": "Primary Podiatric Medicine Podiatrist",
"LicenseNumber": "1513",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}