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General NPI Number Information
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NPI Number | 1871770669
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Entity Type | Organization
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Legal Business Name | BRAESWOOD FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 8527 W. BELLFORT AVE. SUITE A
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City | HOUSTON
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State | TX
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Zip | 77071-2207
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Country | US
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Telephone | 713-776-3300
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Fax | 713-776-3302
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Provider Business Mailing Address
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Address Line | 8527 W. BELLFORT AVE. SUITE A
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City | HOUSTON
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State | TX
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Zip | 77071-2207
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Country | US
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Telephone | 713-776-3300
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Fax | 713-776-3302
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PAULINE MBAWUIKE AHAM-NEZE
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Credential | MD,MPH
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Telephone | 713-776-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | K4146
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License Number State | TX
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