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General NPI Number Information
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NPI Number | 1366940470
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Entity Type | Organization
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Legal Business Name | PATRICIA ROBERTS HARRIS DO PLLC
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2529 E LANCASTER AVE STE A
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City | FORT WORTH
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State | TX
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Zip | 76103-2253
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Country | US
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Telephone | 817-534-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 2529 E LANCASTER AVE STE A
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City | FORT WORTH
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State | TX
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Zip | 76103-2253
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Country | US
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Telephone | 817-534-7300
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. PATRICIA L ROBERTS
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Credential | DO
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Telephone | 817-534-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L1186
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License Number State | TX
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