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General NPI Number Information
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NPI Number | 1508036963
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Entity Type | Organization
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Legal Business Name | EXPRESSIONS PAIN AND REHAB, P.A.
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Dates
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Enumeration Date | 03/01/2008
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Last Update Date | 03/01/2008
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Provider Practice Location Address
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Address Line | 510 W FM 1382
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City | CEDAR HILL
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State | TX
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Zip | 75104-5322
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Country | US
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Telephone | 972-291-9165
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222093
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City | DALLAS
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State | TX
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Zip | 75222-2093
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Country | US
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Telephone | 972-291-9165
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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. BENJAMIN CHARLES DAGLEY
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Credential | D.O.
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Telephone | 972-291-9165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | L9668
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | L9668
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License Number State | TX
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