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General NPI Number Information
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NPI Number | 1053551580
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Entity Type | Organization
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Legal Business Name | CITIMED EAST
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 3310 S. WATSON ROAD
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City | ARLINGTON
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State | TX
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Zip | 76014
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Country | US
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Telephone | 817-704-6930
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Fax | 817-704-6935
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Provider Business Mailing Address
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Address Line | 3310 S.WATSON ROAD
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City | ARLINGTON
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State | TX
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Zip | 76014
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Country | US
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Telephone | 817-704-6930
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Fax | 817-704-6935
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. POHN P INTHANOUSAY
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Credential | D.O.
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Telephone | 817-704-6930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J9103
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License Number State | TX
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