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General NPI Number Information
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NPI Number | 1639170202
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Entity Type | Individual
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Provider Name | SUSAN KAY EASLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 2027 61ST ST WEST ISLE URGENT CARE
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City | GALVESTON
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State | TX
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Zip | 77561
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Country | US
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Telephone | 409-744-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 609 CONSTELLATION BLVD
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City | LEAGUE CITY
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State | TX
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Zip | 77573-6431
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Country | US
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Telephone | 832-932-5812
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Fax |
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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 | N6273
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License Number State | TX
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