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General NPI Number Information
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NPI Number | 1144430802
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PRIDE ORTHOPAEDICS
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 500 POPLAR ST SUITE 303
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City | CHARLESTON
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State | WV
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Zip | 25309-1474
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Country | US
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Telephone | 304-766-7374
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Fax | 304-766-9690
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Provider Business Mailing Address
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Address Line | 500 POPLAR ST SUITE 303
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City | CHARLESTON
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State | WV
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Zip | 25309-1474
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Country | US
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Telephone | 304-766-7374
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Fax | 304-766-9690
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRUCE F HAUPT
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Credential | MD
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Telephone | 304-744-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 18234
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License Number State | WV
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