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General NPI Number Information
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NPI Number | 1235566993
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY MEDICAL CENTER OF SOUTH TEXAS, PA
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 2344 LAGUNA DEL MAR CT STE 101
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City | LAREDO
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State | TX
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Zip | 78045
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Country | US
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Telephone | 956-729-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 2344 LAGUNA DEL MAR CT STE 101
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City | LAREDO
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State | TX
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Zip | 78045-0059
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Country | US
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Telephone | 956-729-7700
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. NEDIL ALDARONDO ANTONINI
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Credential | MD FAAD
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Telephone | 956-729-7700
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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 | K9972
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License Number State | TX
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