{
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"NamePrefix": null,
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"FirstLineMailingAddress": "5830 E 2ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CASPER",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82609-4308",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-345-2703",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "JAVIER EZQUERR GOMEZ",
"SecondLinePracticeLocationAddress": "HIDALGO 148B",
"PracticeLocationAddressCityName": "CHAPALA",
"PracticeLocationAddressStateName": "JALSICO",
"PracticeLocationAddressPostalCode": "45922",
"PracticeLocationAddressCountryCode": "MX",
"PracticeLocationAddressTelephoneNumber": "888-449-7799",
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"EnumerationDate": "07/21/2025",
"LastUpdateDate": "07/21/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOMEZ",
"AuthorizedOfficialFirstName": "JAVIER",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}