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General NPI Number Information
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NPI Number | 1841222189
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Entity Type | Individual
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Provider Name | BILL JEFFREY MATHIAS MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 4800 NE STALLINGS STE 1100
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City | NACOGDOCHES
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State | TX
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Zip | 75965
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Country | US
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Telephone | 936-560-4100
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Fax | 936-560-6093
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Provider Business Mailing Address
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Address Line | 3624 BUCKINGHAM DRIVE
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City | NACOGDOCHES
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State | TX
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Zip | 75965
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Country | US
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Telephone | 936-569-6041
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Fax | 936-560-6093
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | J8312
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License Number State | TX
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