{
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "831 SR L THORNTON FWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-948-7783",
"MailingAddressFaxNumber": "214-948-7793",
"FirstLinePracticeLocationAddress": "831 SR L THORNTON FWY",
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"PracticeLocationAddressCityName": "DALLAS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "214-948-7783",
"PracticeLocationAddressFaxNumber": "214-948-7793",
"EnumerationDate": "11/21/2006",
"LastUpdateDate": "09/06/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WASHINGTON",
"AuthorizedOfficialFirstName": "RONALD",
"AuthorizedOfficialMiddleName": "JEFFREY",
"AuthorizedOfficialTitle": "OWNER ADMINISTRATOR",
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"AuthorizedOfficialCredential": "M.D",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": "E1172",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}