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General NPI Number Information
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NPI Number | 1225047863
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Entity Type | Individual
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Provider Name | STUART P LEVENTHAL MD
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 123 MCCOMB AVE
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City | PORT GIBSON
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State | MS
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Zip | 39150-2915
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Country | US
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Telephone | 601-437-5141
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 320863
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City | FLOWOOD
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State | MS
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Zip | 39232-0863
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Country | US
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Telephone | 601-919-6590
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19158
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License Number State | MS
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