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General NPI Number Information
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NPI Number | 1902131774
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Entity Type | Individual
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Provider Name | BRYAN HANEY MOLEN DPM
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Gender | Male
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 305 REGENCY PKWY STE 801
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City | MANSFIELD
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State | TX
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Zip | 76063-3794
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Country | US
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Telephone | 682-223-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1759 BROAD PARK CIR S STE 205
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City | MANSFIELD
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State | TX
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Zip | 76063-7834
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Country | US
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Telephone | 682-223-2400
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Fax | 682-207-6612
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901002340
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License Number State | MI
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