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General NPI Number Information
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NPI Number | 1295245967
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Entity Type | Individual
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Provider Name | VINCENT MCADAM PORTER
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Gender | Male
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 303 E AIRLINE RD STE 4
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City | VICTORIA
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State | TX
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Zip | 77901-3957
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Country | US
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Telephone | 361-575-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 110 VERSAILLES ST
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City | VICTORIA
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State | TX
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Zip | 77904-2216
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Country | US
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Telephone | 361-676-8466
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 63598
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License Number State | TX
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