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General NPI Number Information
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NPI Number | 1295112704
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Entity Type | Individual
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Provider Name | TIANA RAE ENDICOTT-YAZDANI M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 3500 GASTON AVE
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City | DALLAS
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State | TX
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Zip | 75246-2017
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Country | US
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Telephone | 214-820-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 LOCH HAVEN DR
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City | PLANO
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State | TX
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Zip | 75023-5406
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Country | US
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Telephone | 469-834-6534
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | T1059
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License Number State | TX
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