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General NPI Number Information
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NPI Number | 1881032720
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Entity Type | Organization
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Legal Business Name | J OLIVIERI PROFESSIONAL HEALTH NETWORK LLC
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 6300 SAMUELL BLVD STE 120
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City | DALLAS
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State | TX
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Zip | 75228-7137
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Country | US
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Telephone | 214-381-1910
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Fax | 214-381-2868
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Provider Business Mailing Address
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Address Line | 5200 PAIGE RD SUITE 600
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City | THE COLONY
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State | TX
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Zip | 75056-2121
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Country | US
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Telephone | 972-697-8580
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Fax | 214-245-5915
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIO C OLIVIERI
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Credential | MD
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Telephone | 972-697-8580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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