{
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"FirstLineMailingAddress": "6116 BROADWAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78209",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-824-1281",
"MailingAddressFaxNumber": "210-828-3006",
"FirstLinePracticeLocationAddress": "6116 BROADWAY ST",
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"PracticeLocationAddressCityName": "SAN ANTONIO",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "210-828-3006",
"EnumerationDate": "08/09/2005",
"LastUpdateDate": "03/04/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OTTMERS",
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"AuthorizedOfficialTelephoneNumber": "210-824-1281",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Land Ambulance",
"LicenseNumber": "015027",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}