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General NPI Number Information
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NPI Number | 1164774923
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Entity Type | Organization
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Legal Business Name | SM MALOFF MD PC
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 285 VISTA DR
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City | POCATELLO
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State | ID
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Zip | 83201-4987
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Country | US
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Telephone | 208-239-0380
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Fax | 208-233-6983
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Provider Business Mailing Address
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Address Line | 444 HOSPITAL WAY STE 477
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City | POCATELLO
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State | ID
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Zip | 83201-2744
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Country | US
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Telephone | 208-239-0380
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Fax | 208-233-6983
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN M MALOFF
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Credential | MD
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Telephone | 208-239-0380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | M 3508
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License Number State | ID
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