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General NPI Number Information
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NPI Number | 1376835439
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Entity Type | Individual
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Provider Name | SAMAIRA J KHAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2011
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 2000 SCENIC DR
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City | GEORGETOWN
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State | TX
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Zip | 78626-7726
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Country | US
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Telephone | 917-628-6617
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5703
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City | ROUND ROCK
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State | TX
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Zip | 78683-5703
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Country | US
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Telephone | 512-308-3969
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | R1563
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 275112
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License Number State | NY
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