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General NPI Number Information
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NPI Number | 1235283425
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Entity Type | Organization
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Legal Business Name | JEFFREY D DECAPRIO MD PA
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 2717 SUMMERHILL RD
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City | TEXARKANA
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State | TX
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Zip | 75503-3957
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Country | US
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Telephone | 903-794-0022
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Fax | 903-794-0023
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Provider Business Mailing Address
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Address Line | PO BOX 6124
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City | TEXARKANA
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State | TX
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Zip | 75505-6124
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Country | US
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Telephone | 903-255-0002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY D DECAPRIO MD
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Credential | MD
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Telephone | 903-255-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | K0284
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License Number State | TX
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