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General NPI Number Information
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NPI Number | 1578635835
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Entity Type | Individual
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Provider Name | MICHAEL J BOUTHILLETTE MD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 601 E. SAN ANTONIO STE 203 W
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City | VICTORIA
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State | TX
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Zip | 77901
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Country | US
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Telephone | 361-485-1885
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Fax | 361-578-4486
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Provider Business Mailing Address
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Address Line | PO BOX 8691
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City | BELFAST
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State | ME
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Zip | 04915-8691
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Country | US
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Telephone | 877-848-1463
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Fax | 615-465-3017
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | F0897
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License Number State | TX
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