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General NPI Number Information
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NPI Number | 1235296864
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Entity Type | Individual
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Provider Name | JOHN CHATFIELD HISERODT M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 7707 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4207
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Country | US
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Telephone | 714-902-1762
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Fax | 657-400-9073
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Provider Business Mailing Address
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Address Line | 7707 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4207
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Country | US
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Telephone | 714-902-1762
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Fax | 657-400-9073
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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 | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | G77372
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License Number State | CA
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