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General NPI Number Information
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NPI Number | 1609104785
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Entity Type | Individual
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Provider Name | AYOTUNDE GREGORY FAWEYA MD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 15210 I-45 SOUTH SUITE 110
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City | CONROE
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State | TX
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Zip | 77384-4105
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Country | US
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Telephone | 936-270-8655
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Fax | 936-270-8739
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Provider Business Mailing Address
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Address Line | 500 MEDICAL CENTER BLVD STE 350
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City | CONROE
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State | TX
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Zip | 77304-2878
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Country | US
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Telephone | 936-270-8655
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Fax | 936-270-8739
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2009-01988
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 28250
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME111094
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P4646
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License Number State | TX
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