{
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"IsOrgSubpart": "N",
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"NamePrefix": null,
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"FirstLineMailingAddress": "3225 TURTLE CREEK BLVD",
"SecondLineMailingAddress": "APT#326",
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75219-5400",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-559-0631",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7005 PASTOR BAILEY DR",
"SecondLinePracticeLocationAddress": "STE 101-A",
"PracticeLocationAddressCityName": "DALLAS",
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"PracticeLocationAddressPostalCode": "75237-2649",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-780-0118",
"PracticeLocationAddressFaxNumber": "972-780-0491",
"EnumerationDate": "07/10/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JERIDEAU",
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"AuthorizedOfficialMiddleName": "LAMONT",
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"AuthorizedOfficialTelephoneNumber": "972-780-0118",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}