Full Name | |
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Speciality | Family Medicine |
Location | 1 College Hl, Canton, Missouri |
Authorized Official Name and Position | Mouzon Bass (AGENT) |
Authorized Official Contact | 9723674845 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5050 Spring Valley Rd Dallas TX 75244-3995 Ph: () - | 1 College Hl Canton MO 63435-1257 Ph: (972) 367-4845 |
NPI Number | 1952839789 |
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Provider Enumeration Date | 05/24/2017 |
Last Update Date | 05/24/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952839789 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |