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General NPI Number Information
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NPI Number | 1053738559
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Entity Type | Individual
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Provider Name | JOSE CORTES
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Gender | Male
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 320 E 7TH ST
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City | CENTRALIA
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State | IL
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Zip | 62801-4506
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Country | US
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Telephone | 954-243-0083
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1673
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City | CENTRALIA
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State | IL
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Zip | 62801-9161
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Country | US
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Telephone | 954-865-7512
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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