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General NPI Number Information
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NPI Number | 1134153729
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Entity Type | Individual
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Provider Name | JEFFERSON SVENGSOUK MD
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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 | 07/05/2023
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Provider Practice Location Address
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Address Line | 601 ELMWOOD AVE BOX 655
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City | ROCHESTER
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State | NY
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Zip | 14642-8655
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Country | US
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Telephone | 525-341-3002
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Fax | 585-473-3516
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Provider Business Mailing Address
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Address Line | 601 ELMWOOD AVE BOX 655
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City | ROCHESTER
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State | NY
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Zip | 14642-8655
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Country | US
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Telephone | 525-341-3002
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Fax | 585-473-3516
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 211296
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 211296
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License Number State | NY
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