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General NPI Number Information
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NPI Number | 1447702964
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Entity Type | Organization
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Legal Business Name | WEST FORT WORTH DERMATOLOGY, P.A.
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 09/26/2017
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Provider Practice Location Address
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Address Line | 4840 BRYANT IRVIN CT SUITE 104
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City | FORT WORTH
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State | TX
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Zip | 76107-7679
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Country | US
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Telephone | 817-989-0300
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Fax | 817-377-0970
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Provider Business Mailing Address
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Address Line | 4840 BRYANT IRVIN CT SUITE 104
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City | FORT WORTH
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State | TX
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Zip | 76107-7679
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Country | US
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Telephone | 817-989-0300
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Fax | 817-377-0970
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. LAURA FURNISS MORRIS
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Credential | M.D.
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Telephone | 817-713-4301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | H7639
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License Number State | TX
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