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General NPI Number Information
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NPI Number | 1750701991
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Entity Type | Organization
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Legal Business Name | JACQUIN P MATTHEWS MD PLLC
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 851 W TERRELL AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3161
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Country | US
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Telephone | 817-870-1551
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Fax | 817-870-1818
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Provider Business Mailing Address
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Address Line | 851 W TERRELL AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3161
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Country | US
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Telephone | 817-870-1551
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Fax | 817-870-1818
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Authorized Official
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Title or Position | OWNER
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Name | JACQUIN P MATTHEWS
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Credential | MD
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Telephone | 817-870-1551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | J4909
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License Number State | TX
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