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General NPI Number Information
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NPI Number | 1104222876
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Entity Type | Individual
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Provider Name | MICHELLE L. SMITH M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 39400 PASEO PADRE PARKWAY
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City | FREMONT
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State | CA
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Zip | 94538
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Country | US
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Telephone | 858-832-8963
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 5005, PMB #46
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City | RANCHO SANTE FE
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State | CA
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Zip | 92067
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Country | US
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Telephone | 858-832-8963
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G059152
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License Number State | CA
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