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General NPI Number Information
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NPI Number | 1386939130
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Entity Type | Individual
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Provider Name | SAMUEL KOVALSKI PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 4461 COIT RD SUITE 405
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City | FRISCO
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State | TX
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Zip | 75035-0521
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Country | US
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Telephone | 972-377-9200
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Fax | 972-377-9300
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Provider Business Mailing Address
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Address Line | 9101 LYNDON B JOHNSON FWY SUITE 710
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City | DALLAS
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State | TX
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Zip | 75243-2057
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Country | US
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Telephone | 972-792-5700
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Fax | 972-788-4707
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA04823
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License Number State | TX
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