{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "LIVE OAK ALLERGY & ASTHMA CLINIC; PA",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11515 TOEPPERWEIN RD.",
"SecondLineMailingAddress": "#202",
"MailingAddressCityName": "LIVE OAK",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78233-3166",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-646-6978",
"MailingAddressFaxNumber": "210-646-6979",
"FirstLinePracticeLocationAddress": "11515 TOEPPERWEIN RD.",
"SecondLinePracticeLocationAddress": "#202",
"PracticeLocationAddressCityName": "LIVE OAK",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-646-6978",
"PracticeLocationAddressFaxNumber": "210-646-6979",
"EnumerationDate": "08/30/2006",
"LastUpdateDate": "07/06/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTINEZ",
"AuthorizedOfficialFirstName": "MIGUEL",
"AuthorizedOfficialMiddleName": "JUAN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "210-314-5805",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207KA0200X",
"TaxonomyName": "Allergy Physician",
"LicenseNumber": "H0024",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}