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General NPI Number Information
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NPI Number | 1174960967
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Entity Type | Individual
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Provider Name | WILMER VALENTIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 24540 FM 1314 RD
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City | PORTER
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State | TX
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Zip | 77365-4204
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Country | US
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Telephone | 281-354-4009
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Fax |
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Provider Business Mailing Address
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Address Line | 24540 FM 1314 RD
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City | PORTER
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State | TX
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Zip | 77365-4204
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Country | US
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Telephone | 281-354-4009
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | BP10046926
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | Q6914
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License Number State | TX
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