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General NPI Number Information
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NPI Number | 1043391758
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Entity Type | Individual
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Provider Name | CLYDE CORWIN CLYBOURN MD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 1211B E CLIFF DR
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City | EL PASO
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State | TX
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Zip | 79902-4734
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Country | US
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Telephone | 915-591-6226
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Fax | 915-308-9433
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone | 844-630-0700
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Fax | 877-374-1924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M7914
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License Number State | TX
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