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General NPI Number Information
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NPI Number | 1255813119
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Entity Type | Organization
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Legal Business Name | SOUTHEAST PHYSICIAN NETWORK, P.C.
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 1410 MCFARLAND BLVD N
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2209
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Country | US
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Telephone | 205-345-8208
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Fax | 205-345-8209
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Provider Business Mailing Address
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Address Line | 509 ENERGY CENTER BLVD STE 804
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City | NORTHPORT
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State | AL
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Zip | 35473-2798
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Country | US
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Telephone | 205-366-9740
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Fax | 205-344-9992
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Authorized Official
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Title or Position | CREDENTIALING
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Name | PAMELA HARPER
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Credential |
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Telephone | 205-366-9740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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