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General NPI Number Information
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NPI Number | 1891816617
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Entity Type | Organization
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Legal Business Name | METROPLEX MEDLINK PA
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 2000 NORTH OLD HICKORY TRAIL
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City | DESOTO
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State | TX
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Zip | 75115-7809
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Country | US
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Telephone | 972-223-2760
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7736
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City | DALLAS
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State | TX
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Zip | 75209-0736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES E MATHIS III
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Credential | M.D.
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Telephone | 972-223-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E6497
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License Number State | TX
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