{
"Npi": {
"NPI": "1902897267",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "X",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOAK",
"FirstName": "MICHAEL",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.O.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3634 EAGLE CANYON DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78247-4460",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-495-0313",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3851 ROGER BROOKE DR",
"SecondLinePracticeLocationAddress": "MCHE-QD (CREDENTIALS)",
"PracticeLocationAddressCityName": "FORT SAM HOUSTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78234-4501",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-916-3290",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/04/2005",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "BP10024057",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}