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General NPI Number Information
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NPI Number | 1457652547
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Entity Type | Organization
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Legal Business Name | ALFONSO CORDOBA M.D., P.A.
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 17203 RED OAK DR. SUITE 101
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City | HOUSTON
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State | TX
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Zip | 77090
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Country | US
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Telephone | 281-893-6610
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Fax | 281-893-3658
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Provider Business Mailing Address
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Address Line | P.O. BOX 73626
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City | HOUSTON
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State | TX
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Zip | 77273-3626
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALFONSO CORDOBA
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Credential | M.D., P.A.
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Telephone | 281-893-6610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | F1476
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License Number State | TX
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