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General NPI Number Information
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NPI Number | 1104056423
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Entity Type | Individual
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Provider Name | PROSHAD NEMATI EFUNE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 5201 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75235
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Country | US
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Telephone | 817-925-9871
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Fax |
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Provider Business Mailing Address
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Address Line | 2723 FOUNTAIN DR
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City | IRVING
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State | TX
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Zip | 75063-3526
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Country | US
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Telephone | 817-925-9871
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | P3213
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P3213
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | P3213
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | P3213
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License Number State | TX
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