{
"Npi": {
"NPI": "1902043060",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADESUBOMI AGORO M.D. P.A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 150929",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76108-0929",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-763-5550",
"MailingAddressFaxNumber": "817-763-5715",
"FirstLinePracticeLocationAddress": "1339 EAST ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAHAM",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76450-4228",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-763-5550",
"PracticeLocationAddressFaxNumber": "817-763-5715",
"EnumerationDate": "01/12/2009",
"LastUpdateDate": "07/16/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AGORO",
"AuthorizedOfficialFirstName": "ADESUBOMI",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "817-763-5550",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RP1001X",
"TaxonomyName": "Pulmonary Disease Physician",
"LicenseNumber": "K2394",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}