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General NPI Number Information
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NPI Number | 1265603351
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Entity Type | Organization
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Legal Business Name | MITCHELL C. SHIRAH M.D. P.C.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 59664 HIGHWAY 22
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City | ROANOKE
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State | AL
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Zip | 36274-4438
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Country | US
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Telephone | 334-863-8951
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Fax | 334-863-2361
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Provider Business Mailing Address
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Address Line | 59664 HIGHWAY 22
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City | ROANOKE
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State | AL
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Zip | 36274-4438
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Country | US
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Telephone | 334-863-8951
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Fax | 334-863-2361
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. STEPHANIE LYNN ESTES
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Credential | RN, BSN
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Telephone | 334-863-8951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9705
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License Number State | AL
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