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General NPI Number Information
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NPI Number | 1962136044
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Entity Type | Individual
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Provider Name | DEVON ELDER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 7106 SANGER RD
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City | WACO
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State | TX
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Zip | 76712-3928
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Country | US
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Telephone | 254-537-1265
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 RANCH ROAD 2222, BLDG 1, STE 200
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City | AUSTIN
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State | TX
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Zip | 78730-3255
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Country | US
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Telephone | 512-628-0465
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15694
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License Number State | TX
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