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General NPI Number Information
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NPI Number | 1245360726
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Entity Type | Individual
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Provider Name | JAIME E RUIZ MONTERO MD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 4320 FIR STREET SUITE 410
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3052
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Country | US
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Telephone | 219-397-8965
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Fax | 219-397-9351
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Provider Business Mailing Address
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Address Line | 9660 WICKER AVENUE
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City | ST JOHN
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State | IN
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Zip | 46373-9487
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Country | US
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Telephone | 219-397-8965
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Fax | 219-397-9351
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01052348
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01052348A
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License Number State | IN
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