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General NPI Number Information
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NPI Number | 1124202197
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Entity Type | Organization
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Legal Business Name | MATTHEW H ROBERTS
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 310 2ND AVE SW STE 208
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City | MIAMI
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State | OK
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Zip | 74354-6702
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Country | US
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Telephone | 918-540-7655
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Fax | 918-540-7668
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Provider Business Mailing Address
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Address Line | PO BOX 1323
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City | MIAMI
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State | OK
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Zip | 74355-1323
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Country | US
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Telephone | 918-540-7655
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Fax | 918-540-7668
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW H ROBERTS
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Credential | DPM
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Telephone | 918-540-7655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 223
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License Number State | OK
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