{
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"FirstLineMailingAddress": "10840 TEXAS HEALTH TRL",
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"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-753-7029",
"MailingAddressFaxNumber": "817-753-7039",
"FirstLinePracticeLocationAddress": "10840 TEXAS HEALTH TRL",
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"PracticeLocationAddressFaxNumber": "817-753-7039",
"EnumerationDate": "01/24/2007",
"LastUpdateDate": "10/17/2012",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LONG",
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"AuthorizedOfficialTelephoneNumber": "817-753-7029",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Surgery Physician",
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"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}