{
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"FirstLineMailingAddress": "63 N BACOPA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THE WOODLANDS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77389-4980",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "832-415-9542",
"FirstLinePracticeLocationAddress": "13215 DOTSON RD",
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"EnumerationDate": "03/20/2013",
"LastUpdateDate": "03/20/2013",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOFOLA",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Surgery Physician",
"LicenseNumber": "N0472",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}