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General NPI Number Information
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NPI Number | 1982147690
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Entity Type | Organization
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Legal Business Name | MYWAY MEDICAL
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 20711 LAVONE DR
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City | PORTER
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State | TX
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Zip | 77365-7603
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Country | US
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Telephone | 512-956-9929
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Fax |
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Provider Business Mailing Address
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Address Line | 20711 LAVONE DR
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City | PORTER
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State | TX
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Zip | 77365-7603
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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 | MEDICAL DIRECTOR
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Name | DR. BHARAT MITTAL
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Credential | D.O.
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Telephone | 512-956-9929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | P7313
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License Number State | TX
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