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General NPI Number Information
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NPI Number | 1891770731
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Entity Type | Organization
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Legal Business Name | DENTON PHYSICAL MEDICINE PAIN
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 4320 WINDSOR CENTRE TRL STE 300
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City | FLOWER MOUND
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State | TX
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Zip | 75028-1858
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Country | US
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Telephone | 972-539-1200
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Fax | 972-539-1221
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Provider Business Mailing Address
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Address Line | 5801 SHOREFRONT LN
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City | FLOWER MOUND
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State | TX
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Zip | 75022-5698
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Country | US
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Telephone | 972-539-1200
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Fax | 972-539-1221
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PARCHELLE DENIESE CONNALLY
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Credential | MD
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Telephone | 972-539-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | J8969
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | J8969
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License Number State | TX
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