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General NPI Number Information
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NPI Number | 1083789002
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Entity Type | Organization
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Legal Business Name | TERRY A. CLYBURN, M. D., P.A.
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 5420 WEST LOOP S SUITE 2400
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City | BELLAIRE
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State | TX
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Zip | 77401-2107
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Country | US
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Telephone | 713-357-4752
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Fax | 832-213-0308
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Provider Business Mailing Address
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Address Line | PO BOX 4356 DEPT. 967
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City | HOUSTON
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State | TX
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Zip | 77210-4356
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Country | US
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Telephone | 713-357-4752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY ALAN CLYBURN
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Credential | M. D.
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Telephone | 713-357-4752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | F3846
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License Number State | TX
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