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General NPI Number Information
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NPI Number | 1174560726
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Entity Type | Individual
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Provider Name | CHARLES ERIC VINSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 3201 W HIGHWAY 22
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City | CORSICANA
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State | TX
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Zip | 75110-2450
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Country | US
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Telephone | 903-654-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 BRANCH CREEK RD
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City | VENUS
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State | TX
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Zip | 76084-3304
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Country | US
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Telephone | 817-360-6242
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C-7341
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | J0714
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License Number State | TX
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