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General NPI Number Information
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NPI Number | 1811991524
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Entity Type | Organization
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Legal Business Name | CONROE FAMILY MEDICINE, PA
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 3205 W DAVIS ST STE B150
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City | CONROE
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State | TX
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Zip | 77304-2066
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Country | US
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Telephone | 936-756-6661
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Fax | 936-756-6681
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Provider Business Mailing Address
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Address Line | 3205 W DAVIS ST STE B150
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City | CONROE
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State | TX
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Zip | 77304-2066
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Country | US
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Telephone | 936-756-6661
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Fax | 936-756-6681
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JACK PIENIAZEK
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Credential | DO
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Telephone | 936-756-6661
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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 | K0541
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License Number State | TX
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