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General NPI Number Information
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NPI Number | 1205875051
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Entity Type | Individual
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Provider Name | JOHN PAUL LELAND DO
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1701 LACEY ST
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-5230
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Country | US
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Telephone | 573-339-7699
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Fax | 573-339-7644
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Provider Business Mailing Address
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Address Line | 2704 INDEPENDENCE ST APT 8
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-5014
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Country | US
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Telephone | 573-339-7699
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Fax | 573-339-7644
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2004028646
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License Number State | MO
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