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General NPI Number Information
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NPI Number | 1205860392
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Entity Type | Individual
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Provider Name | KERRY K FORD MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 03/25/2012
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Provider Practice Location Address
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Address Line | 510 E 15TH ST
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City | GEORGETOWN
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State | TX
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Zip | 78626-6941
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Country | US
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Telephone | 512-948-7093
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2987
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City | GEORGETOWN
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State | TX
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Zip | 78627-2987
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Country | US
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Telephone | 512-948-7093
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | E6080
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License Number State | TX
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