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General NPI Number Information
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NPI Number | 1104859107
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Entity Type | Individual
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Provider Name | WILLIAM STEPHEN MINORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 1235 N MULFORD RD STE 222
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City | ROCKFORD
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State | IL
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Zip | 61107-3879
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Country | US
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Telephone | 815-397-8400
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Fax | 815-229-0050
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Provider Business Mailing Address
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Address Line | 2202 HARLEM RD
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City | LOVES PARK
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State | IL
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Zip | 61111-2754
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Country | US
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Telephone | 815-877-4848
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Fax | 815-654-5342
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036-075603
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036.075603
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License Number State | IL
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