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General NPI Number Information
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NPI Number | 1194912832
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Entity Type | Organization
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Legal Business Name | HORIZON VEIN LASER&AESTHETICS CLINIC PA
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 6020 W PARKER RD SUITE #300
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City | PLANO
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State | TX
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Zip | 75093-8171
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Country | US
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Telephone | 972-661-8884
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Fax | 972-980-4100
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Provider Business Mailing Address
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Address Line | PO BOX 803311
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City | DALLAS
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State | TX
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Zip | 75380-3311
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Country | US
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Telephone | 972-661-8884
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Fax | 972-980-4100
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DANIEL SHALEV
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Credential | M.D.
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Telephone | 972-980-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G7721
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License Number State | TX
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