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General NPI Number Information
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NPI Number | 1073636551
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Entity Type | Organization
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Legal Business Name | WADE FALWELL, M.D.,P.A.
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 2000 MCLAIN ST SUITE G
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City | NEWPORT
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State | AR
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Zip | 72112-3661
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Country | US
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Telephone | 870-523-3053
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Fax | 870-523-3637
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Provider Business Mailing Address
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Address Line | 2000 MCLAIN ST SUITE G
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City | NEWPORT
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State | AR
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Zip | 72112-3661
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Country | US
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Telephone | 870-523-3053
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Fax | 870-523-3637
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBRA K FALWELL
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Credential |
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Telephone | 870-523-3053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 207Q00000X
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License Number State | AR
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