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General NPI Number Information
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NPI Number | 1003132093
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Entity Type | Individual
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Provider Name | MITCHELL CONSTANT PA
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Gender | Male
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 1640 OLD PECOS TRAIL, SUITE H HEALTH FRONT, PC
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-992-0233
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Fax |
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Provider Business Mailing Address
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Address Line | 7247 WILD OLIVE AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2077
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Country | US
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Telephone | 505-797-0501
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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 |
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License Number State |
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