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General NPI Number Information
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NPI Number | 1477901288
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH CENTER OF MISSION, PLLC
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 1920 E GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-3106
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Country | US
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Telephone | 956-584-3353
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 E GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-3106
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Country | US
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Telephone | 956-584-3353
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERE M JOHNSON
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Credential | M.D.
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Telephone | 956-584-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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