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General NPI Number Information
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NPI Number | 1104072818
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Entity Type | Individual
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Provider Name | PATRICE ELAINE MOONEY DO
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Gender | Female
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 501 SE FLOWER MOUND RD
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City | LAWTON
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State | OK
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Zip | 73501-6388
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Country | US
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Telephone | 580-351-6511
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Fax |
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Provider Business Mailing Address
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Address Line | 5822 E 64TH ST
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City | TULSA
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State | OK
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Zip | 74136-2137
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Country | US
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Telephone | 405-248-2844
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4043
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License Number State | OK
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