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General NPI Number Information
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NPI Number | 1336121490
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Entity Type | Organization
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Legal Business Name | MONTANA MEDICAL CLINIC-MANUEL HERNANDEZ,M.D.
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 2415 MONTANA AVE
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City | EL PASO
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State | TX
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Zip | 79903-3605
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Country | US
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Telephone | 915-533-3353
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Fax | 915-544-4353
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Provider Business Mailing Address
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Address Line | 2415 MONTANA AVE
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City | EL PASO
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State | TX
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Zip | 79903-3605
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Country | US
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Telephone | 915-533-3353
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Fax | 915-544-4353
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Authorized Official
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Title or Position | NUEROPHYCHIATRY - GENERAL PRACTICE
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Name | DR. MANUEL HERNANDEZ
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Credential | M.D.
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Telephone | 915-533-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | C5088
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License Number State | TX
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