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General NPI Number Information
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NPI Number | 1679678205
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Entity Type | Individual
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Provider Name | WILLIAM BRIAN WOMACK D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 1611 JOY LN
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-8807
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Country | US
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Telephone | 928-768-9496
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Fax |
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Provider Business Mailing Address
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Address Line | P.0. BOX 9479
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City | FORT MOHAVE
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State | AZ
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Zip | 86426
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Country | US
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Telephone | 928-768-9496
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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 | 3527
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License Number State | AZ
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