{
"Npi": {
"NPI": "1891004420",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PETER GREEN MD PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 6337",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76115-0337",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-293-2944",
"MailingAddressFaxNumber": "817-293-2039",
"FirstLinePracticeLocationAddress": "11801 SOUTH FWY",
"SecondLinePracticeLocationAddress": "SUITE 234",
"PracticeLocationAddressCityName": "BURLESON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76028-7021",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-293-2944",
"PracticeLocationAddressFaxNumber": "817-293-2039",
"EnumerationDate": "09/30/2010",
"LastUpdateDate": "09/30/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREEN",
"AuthorizedOfficialFirstName": "PETER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MD",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "817-293-2944",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "F8497",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}