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General NPI Number Information
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NPI Number | 1467632737
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Entity Type | Organization
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Legal Business Name | ALLIANCE HEALTH PROVIDERS OF THE BRAZOS VALLEY
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1328 MEMORIAL DR SUITE B
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City | BRYAN
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State | TX
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Zip | 77802-5237
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Country | US
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Telephone | 979-846-2489
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Fax | 979-776-3026
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Provider Business Mailing Address
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Address Line | 1328 MEMORIAL DR SUITE B
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City | BRYAN
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State | TX
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Zip | 77802-5237
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Country | US
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Telephone | 979-846-2489
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Fax | 979-776-3026
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JAMES VOGEL
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Credential | RHU
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Telephone | 979-846-2489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | TX
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