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General NPI Number Information
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NPI Number | 1225611627
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Entity Type | Individual
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Provider Name | JASON LEONARD RAYZOR CSFA
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Gender | Male
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 501 AIRPORT RD
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City | RIFLE
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State | CO
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Zip | 81650-8510
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Country | US
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Telephone | 970-625-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 14 JESSICA LN
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City | PARACHUTE
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State | CO
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Zip | 81635-9744
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Country | US
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Telephone | 574-612-5801
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA.0002746
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License Number State | CO
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