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General NPI Number Information
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NPI Number | 1043458441
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Entity Type | Individual
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Provider Name | JESSE MICHAEL BROOME M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 840 FIRST COLONIAL RD SUITE 102B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6106
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Country | US
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Telephone | 757-351-6226
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Fax | 757-351-6848
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Provider Business Mailing Address
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Address Line | 840 FIRST COLONIAL RD SUITE 102B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6106
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Country | US
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Telephone | 757-351-6226
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Fax | 757-351-6848
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101036999
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License Number State | VA
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