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General NPI Number Information
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NPI Number | 1881128312
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Entity Type | Individual
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Provider Name | DAVITA FORD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 4006 BIRCH HAVEN DR
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City | KINGWOOD
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State | TX
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Zip | 77339-1319
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Country | US
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Telephone | 346-345-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 4582 KINGWOOD DR STE E
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City | KINGWOOD
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State | TX
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Zip | 77345-2640
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Country | US
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Telephone | 346-325-2408
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2898
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License Number State | TX
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