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General NPI Number Information
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NPI Number | 1225370828
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Entity Type | Individual
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Provider Name | ALHARETH M AL JUBOORI M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 101 S FAIRVIEW RD
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City | COLUMBIA
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State | MO
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Zip | 65203-7637
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Country | US
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Telephone | 573-884-7600
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Fax | 573-884-8200
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Provider Business Mailing Address
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Address Line | 3501 N SCOTTSDALE RD STE 320
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-5650
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Country | US
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Telephone | 480-882-5740
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2017010212
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 64902
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License Number State | AZ
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