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General NPI Number Information
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NPI Number | 1144287681
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Entity Type | Individual
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Provider Name | VINCENT M BOURNIQUE MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 8075 N SHADELAND AVE #350
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2693
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Country | US
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Telephone | 317-678-3900
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Fax | 317-841-0395
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Provider Business Mailing Address
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Address Line | 1600 S 20TH AVE #350
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City | SAFFORD
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State | AZ
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Zip | 85546-4011
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Country | US
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Telephone | 928-348-4037
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Fax | 855-876-8606
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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 | 01029804A
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License Number State | IN
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