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General NPI Number Information
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NPI Number | 1578077871
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Entity Type | Organization
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Legal Business Name | MD MEDICAL MANAGEMENT LLC
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 1140 WESTMONT DR STE 515
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City | HOUSTON
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State | TX
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Zip | 77015-4365
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Country | US
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Telephone | 832-623-5583
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Fax | 832-802-6171
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Provider Business Mailing Address
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Address Line | 1140 WESTMONT DR STE 515
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City | HOUSTON
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State | TX
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Zip | 77015-4365
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Country | US
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Telephone | 832-623-5583
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Fax | 832-623-6939
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Authorized Official
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Title or Position | CREDENTIALING OFFICER
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Name | OFFICE CREDENTIALIN
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Credential |
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Telephone | 832-623-5583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | J3003
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License Number State | TX
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