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General NPI Number Information
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NPI Number | 1740488220
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Entity Type | Organization
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Legal Business Name | UNIVERSITY SPORTS & FAMILY MEDICINE
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3201 UNIVERSITY DR E SUITE 440
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City | BRYAN
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State | TX
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Zip | 77802-3475
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Country | US
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Telephone | 979-776-2800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21171
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City | WACO
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State | TX
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Zip | 76702-1171
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRIS MIARS
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Credential | DO
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Telephone | 254-716-6685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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