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General NPI Number Information
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NPI Number | 1568470136
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Entity Type | Organization
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Legal Business Name | MID COUNTY MEDICAL GROUP PA
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 2501 JIMMY JOHNSON BLVD STE 110A
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City | PORT ARTHUR
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State | TX
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Zip | 77640-2000
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Country | US
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Telephone | 409-344-4466
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Fax | 409-600-8525
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Provider Business Mailing Address
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Address Line | 2940 SPURLOCK RD
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City | NEDERLAND
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State | TX
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Zip | 77627-6313
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Country | US
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Telephone | 409-344-4466
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | MICHAEL L MCMAHON
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Credential | M.D.
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Telephone | 409-344-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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