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General NPI Number Information
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NPI Number | 1144464215
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Entity Type | Organization
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Legal Business Name | MOBILE PODIATRIC MEDICINE, PLLC
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 603 WYCLIFFE DR
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City | HOUSTON
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State | TX
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Zip | 77079-3507
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Country | US
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Telephone | 661-547-3114
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 79352
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City | HOUSTON
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State | TX
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Zip | 77279-9352
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Country | US
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Telephone | 661-547-3114
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | VERNON E. REYES
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Credential | DPM
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Telephone | 661-547-3114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1765
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License Number State | TX
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