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General NPI Number Information
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NPI Number | 1154334936
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Entity Type | Individual
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Provider Name | PRASHANT K MUKERJEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 35673 COUNTRY PARK DR
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City | WILDOMAR
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State | CA
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Zip | 92595-7840
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Country | US
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Telephone | 951-973-8130
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Fax | 951-808-0957
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Provider Business Mailing Address
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Address Line | 27890 CLINTON KEITH RD STE 2 MAIL BOX 380
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City | MURRIETA
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State | CA
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Zip | 92562-8571
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Country | US
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Telephone | 951-973-8130
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Fax | 951-808-0957
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | C54408
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD016833E
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License Number State | PA
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