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General NPI Number Information
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NPI Number | 1265431241
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Entity Type | Individual
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Provider Name | MITCHELL FADOUL KEAMY III M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 2850 S MOJAVE RD LOT A
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City | LAS VEGAS
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State | NV
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Zip | 89121
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Country | US
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Telephone | 702-386-4700
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Fax | 702-386-4701
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Provider Business Mailing Address
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Address Line | 3157 N RAINBOW BLVD # 518
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City | LAS VEGAS
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State | NV
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Zip | 89108-4578
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Country | US
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Telephone | 702-877-8661
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Fax | 702-877-5140
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5653
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License Number State | NV
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