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General NPI Number Information
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NPI Number | 1922068733
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Entity Type | Individual
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Provider Name | DONOVAN MITCHELL SIMMONS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 12221 N MO PAC EXPY
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City | AUSTIN
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State | TX
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Zip | 78758-2401
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Country | US
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Telephone | 512-306-1903
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Fax | 512-306-0107
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Provider Business Mailing Address
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Address Line | PO BOX 4268
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City | AUSTIN
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State | TX
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Zip | 78765-4268
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Country | US
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Telephone | 512-306-1903
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Fax | 512-306-0107
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L6180
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License Number State | TX
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