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General NPI Number Information
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NPI Number | 1750563276
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE CLINIC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 17203 RED OAK DR SUITE 201
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City | HOUSTON
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State | TX
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Zip | 77090-2640
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Country | US
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Telephone | 281-880-9710
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Fax | 281-880-9711
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Provider Business Mailing Address
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Address Line | PO BOX 11220
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City | HOUSTON
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State | TX
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Zip | 77293-1220
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Country | US
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Telephone | 281-880-9710
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Fax | 281-880-9711
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Authorized Official
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Title or Position | DOCTOR
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Name | RAFAEL G BORGES
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Credential | MD
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Telephone | 281-880-9710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | K9230
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License Number State | TX
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