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General NPI Number Information
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NPI Number | 1164482337
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Entity Type | Organization
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Legal Business Name | EAGLE SPRINGS FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 903 E. HIGHWAY 260, SUITE 4
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City | PAYSON
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State | AZ
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Zip | 85541
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Country | US
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Telephone | 928-468-7700
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Fax | 928-468-7703
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Provider Business Mailing Address
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Address Line | 903 E. HWY 260 SUITE 4
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City | PAYSON
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State | AZ
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Zip | 85541
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Country | US
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Telephone | 928-468-7700
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Fax | 928-468-7703
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MATTHEW R. HARRIS
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Credential | DO
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Telephone | 928-468-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4333
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License Number State | AZ
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