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General NPI Number Information
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NPI Number | 1154540862
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Entity Type | Individual
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Provider Name | DIANA TRESSA SAMUEL M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 11615 ANGUS RD SUITE 225
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City | AUSTIN
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State | TX
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Zip | 78759-4078
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Country | US
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Telephone | 512-372-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 5717 TRIBUNE WAY
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City | PLANO
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State | TX
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Zip | 75094-4505
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Country | US
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Telephone |
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | N4061
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | N4061
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License Number State | TX
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