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Individual
DR. VINCENT JOSEPH MANDOLA
Active
Individual
DR. VINCENT JOSEPH MANDOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Q8104
TX
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
Q8104
TX
207RS0010X
Sports Medicine (Internal Medicine) Physician
Q8104
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013352251
NPI
TX
Enumeration date
05/01/2013
Last updated
12/22/2021
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