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General NPI Number Information
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NPI Number | 1871721993
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Entity Type | Individual
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Provider Name | RYAN DAVID SIMONAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 7510 N BEACH ST
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City | FORT WORTH
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State | TX
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Zip | 76137-1505
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Country | US
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Telephone | 817-498-1818
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Fax | 817-581-3761
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Provider Business Mailing Address
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Address Line | 7510 N BEACH ST
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City | FORT WORTH
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State | TX
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Zip | 76137-1505
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Country | US
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Telephone | 817-498-1818
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Fax | 817-581-3761
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LL1273
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | Q2949
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License Number State | TX
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