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General NPI Number Information
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NPI Number | 1093387052
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Entity Type | Individual
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Provider Name | LEARIE N JONES JR.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2021
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Last Update Date | 07/10/2021
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Provider Practice Location Address
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Address Line | 1928 SAINT MARYS RD
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City | MORAGA
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State | CA
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Zip | 94575-2715
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Country | US
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Telephone | 515-333-3079
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Fax |
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Provider Business Mailing Address
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Address Line | 1480 CREEKSIDE DR APT A312
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5510
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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 |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | BOC2000018524
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License Number State | CA
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