Basic Information
Provider Information
NPI: 1225431588
EntityType: 2
ReplacementNPI:  
OrganizationName: CEC OAKMONT ER PHYSICIANS PLLC
LastName:  
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Mailing Information
Address1: PO BOX 92235
Address2:  
City: SOUTHLAKE
State: TX
PostalCode: 760920102
CountryCode: US
TelephoneNumber: 8174210034
FaxNumber: 8174210036
Practice Location
Address1: 7445 OAKMONT BLVD
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761323905
CountryCode: US
TelephoneNumber: 8174210034
FaxNumber: 8174210036
Other Information
ProviderEnumerationDate: 10/01/2014
LastUpdateDate: 10/20/2014
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: NEIMAN
AuthorizedOfficialFirstName: JOHN
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AuthorizedOfficialTitleorPosition: GENERAL COUNSEL
AuthorizedOfficialTelephone: 8174210034
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: ESQ.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207PE0004X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services

No ID Information.


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