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General NPI Number Information
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NPI Number | 1659651552
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Entity Type | Individual
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Provider Name | CHAITANYA GOUD BONDA M.D., MBBS
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Gender | Male
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 2900 MEDICAL CENTER PKWY STE 310
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City | BENTONVILLE
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State | AR
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Zip | 72712-3204
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Country | US
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Telephone | 479-553-3310
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Fax | 479-553-1947
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Provider Business Mailing Address
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Address Line | 5375 COIT RD STE 130
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City | FRISCO
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State | TX
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Zip | 75035-4914
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Country | US
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Telephone | 479-553-3310
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Fax | 479-553-1947
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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 | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | S8421
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License Number State | TX
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