{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "MICHAEL DAVID LARA, MD, PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1655 MOSSWOOD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EL PASO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79935-3435",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "915-383-6679",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10175 GATEWAY BLVD W",
"SecondLinePracticeLocationAddress": "220",
"PracticeLocationAddressCityName": "EL PASO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79925-7618",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "915-383-6679",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/23/2016",
"LastUpdateDate": "05/11/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LARA",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "DAVID",
"AuthorizedOfficialTitle": "PRESIDENT/ OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "915-383-6679",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "L8406",
"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."
}
}
}
}