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General NPI Number Information
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NPI Number | 1518312669
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Entity Type | Organization
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Legal Business Name | MWLC MANSFIELD LLC
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 4000 FIVE POINTS DR STE 169
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City | ARLINGTON
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State | TX
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Zip | 76018-6057
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Country | US
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Telephone | 817-375-0537
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Fax | 817-375-0538
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Provider Business Mailing Address
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Address Line | 2940 HOLLOW VALLEY DR
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City | FORT WORTH
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State | TX
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Zip | 76244-5531
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Country | US
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Telephone | 817-501-8327
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Fax | 817-375-0538
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | TIMOTHY GREGORY
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Credential |
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Telephone | 817-501-8327
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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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