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General NPI Number Information
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NPI Number | 1063443588
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Entity Type | Individual
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Provider Name | SCOTT C CARRIZALES MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 930 TALON DR STE 1
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City | O FALLON
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State | IL
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Zip | 62269-1962
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Country | US
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Telephone | 618-726-1080
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Fax | 618-726-1081
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE C B 8123
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone | 636-447-5197
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Fax | 636-928-0994
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2015003668
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License Number State | MO
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