{
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"FirstLineMailingAddress": "3120 NORTH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEAUMONT",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77702-1420",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "409-898-4484",
"FirstLinePracticeLocationAddress": "3120 NORTH ST",
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"PracticeLocationAddressFaxNumber": "409-898-4484",
"EnumerationDate": "10/26/2005",
"LastUpdateDate": "08/22/2020",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "LAL",
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"AuthorizedOfficialCredential": "MD PA FACOG",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Obstetrics & Gynecology Physician",
"LicenseNumber": "F0553",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}