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General NPI Number Information
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NPI Number | 1477646271
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Entity Type | Organization
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Legal Business Name | WILLIAM NISIMBLAT MDPA
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 305 E THIRD ST
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City | ALICE
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State | TX
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Zip | 78332-4705
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Country | US
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Telephone | 361-664-5291
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Fax | 361-668-1630
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Provider Business Mailing Address
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Address Line | PO BOX 289
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City | ALICE
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State | TX
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Zip | 78333-4705
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Country | US
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Telephone | 361-664-9353
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM NISIMBLAT
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Credential | MD
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Telephone | 361-664-5291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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