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General NPI Number Information
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NPI Number | 1619055365
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Entity Type | Organization
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Legal Business Name | AUSTIN GASTROENTEROLOGY PA
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 8015 SHOAL CREEK BLVD STE 116
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City | AUSTIN
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State | TX
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Zip | 78757-8051
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Country | US
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Telephone | 512-420-0186
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Fax | 512-420-0397
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Provider Business Mailing Address
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Address Line | 8015 SHOAL CREEK BLVD STE 116
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City | AUSTIN
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State | TX
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Zip | 78757-8051
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Country | US
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Telephone | 512-420-0186
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Fax | 512-420-0397
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Authorized Official
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Title or Position | CEO
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Name | DR. BRUCE A LEVY
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Credential | MD, JD
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Telephone | 512-485-5879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 45D1056054
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License Number State | TX
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