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General NPI Number Information
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NPI Number | 1013219203
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Entity Type | Organization
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Legal Business Name | MATTHEW HARRIS, MD, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 23961 CALLE DE LA MAGDALENA SUITE 405
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3616
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Country | US
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Telephone | 949-588-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 23961 CALLE MAGDALENA SUITE 405
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City | LAGUNA HILLS
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State | CA
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Zip | 92653
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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 | CEO
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Name | DR. MATTHEW HARRIS
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Credential | M.D.
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Telephone | 949-588-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A99869
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License Number State | CA
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