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General NPI Number Information
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NPI Number | 1902054679
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Entity Type | Organization
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Legal Business Name | FAMILY CLINIC,PLLC
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 350 COWAN RD
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City | GULFPORT
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State | MS
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Zip | 39507-2008
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Country | US
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Telephone | 228-896-5195
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Fax | 228-897-2395
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Provider Business Mailing Address
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Address Line | 350 COWAN RD
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City | GULFPORT
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State | MS
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Zip | 39507-2008
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Country | US
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Telephone | 228-896-5195
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Fax | 228-897-2395
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Authorized Official
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Title or Position | OWNER
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Name | DR. EUGENE DAVID MCNALLY
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Credential | M.D., M.P.H.
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Telephone | 228-896-5195
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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 | 11462
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License Number State | MS
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