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General NPI Number Information
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NPI Number | 1780189290
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Entity Type | Individual
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Provider Name | JAKE AUSTIN ALFORD MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 1500 COOPER ST
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City | FORT WORTH
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State | TX
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Zip | 76104-2710
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Country | US
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Telephone | 682-885-7770
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Fax | 682-303-1575
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Provider Business Mailing Address
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Address Line | PO BOX 733784
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City | DALLAS
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State | TX
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Zip | 75373-3784
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Country | US
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Telephone | 682-885-6483
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Fax | 682-885-3113
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A164595
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | V8658
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License Number State | TX
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