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General NPI Number Information
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NPI Number | 1033387139
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Entity Type | Organization
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Legal Business Name | SOUTHWEST INSTITUTE OF ARTHROSCOPIC AND RECONSTRUCTIVE SURGERY, LTD.,
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 1056 S VAL VISTA DR SUITE 2
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City | MESA
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State | AZ
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Zip | 85204-5667
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Country | US
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Telephone | 480-834-5480
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Fax | 480-834-3194
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Provider Business Mailing Address
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Address Line | 1056 S VAL VISTA DR SUITE 2
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City | MESA
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State | AZ
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Zip | 85204-5667
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Country | US
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Telephone | 480-834-5480
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Fax | 480-834-3194
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JEFFREY S. LEVINE
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Credential | M.D.
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Telephone | 480-834-5480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 20383
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License Number State | AZ
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