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General NPI Number Information
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NPI Number | 1235399627
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Entity Type | Individual
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Provider Name | JEDIDIAH C LEAF MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 12221 MERIT DR
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City | DALLAS
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State | TX
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Zip | 75251-2202
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Country | US
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Telephone | 214-217-1914
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 GLENBROOK DR
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City | RICHARDSON
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State | TX
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Zip | 75082-3665
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Country | US
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Telephone | 337-296-9666
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | P3643
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD203840
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License Number State | LA
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