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General NPI Number Information
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NPI Number | 1093775629
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Entity Type | Individual
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Provider Name | LARRY D REED M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 400 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2028
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Country | US
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Telephone | 618-498-6402
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Fax |
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Provider Business Mailing Address
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Address Line | 36 GARDEN CTR
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City | BROOMFIELD
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State | CO
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Zip | 80020-1730
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Country | US
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Telephone | 303-465-0401
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Fax | 303-438-1351
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036073586
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R2D52
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License Number State | MO
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