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General NPI Number Information
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NPI Number | 1124027172
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Entity Type | Individual
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Provider Name | PAUL R KOUYOUMDJI MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 4 BY PASS RD SUITE 101
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City | SALEM
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State | NJ
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Zip | 08079-2053
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Country | US
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Telephone | 856-935-3582
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Fax | 856-935-4382
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Provider Business Mailing Address
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Address Line | PO BOX 504290
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City | SAINT LOUIS
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State | MO
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Zip | 63150-0001
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Country | US
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Telephone | 856-935-3582
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Fax | 856-935-4382
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA64453
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License Number State | NJ
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