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General NPI Number Information
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NPI Number | 1679479042
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Entity Type | Organization
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Legal Business Name | FUSION NEURODIAGNOSTICS PLLC
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Dates
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Enumeration Date | 10/14/2026
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Last Update Date | 10/14/2026
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Provider Practice Location Address
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Address Line | 2200 PARK BEND DR STE 202
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City | AUSTIN
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State | TX
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Zip | 78758-5388
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Country | US
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Telephone | 512-836-0900
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Fax | 512-836-0900
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Provider Business Mailing Address
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Address Line | 969 MILLER CREEK CEMETERY RD
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City | JOHNSON CITY
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State | TX
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Zip | 78636-4264
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Country | US
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Telephone | 512-289-3542
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Fax | 512-836-0900
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Authorized Official
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Title or Position | NEUROSURGEON
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Name | DR. THOMAS STUART LOFTUS
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Credential | MD
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Telephone | 512-289-3542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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