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General NPI Number Information
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NPI Number | 1104872381
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Entity Type | Individual
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Provider Name | MARK M CHIN MD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 1103 W LIBERTY ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1921
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Country | US
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Telephone | 573-760-8488
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Fax | 573-756-3793
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Provider Business Mailing Address
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Address Line | 670 MASON RIDGE CENTER DR SUITE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8573
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Country | US
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Telephone | 573-760-8488
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Fax | 573-756-3793
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 36657
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License Number State | MO
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