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General NPI Number Information
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NPI Number | 1265966626
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Entity Type | Organization
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Legal Business Name | C3ERLAS1,PLLC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 5757 WAYNE NEWTON BLVD TERMINAL 1, 2ND FLOOR
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City | LAS VEGAS
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State | NV
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Zip | 89111
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Country | US
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Telephone | 702-846-0020
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Fax | 702-846-0024
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Provider Business Mailing Address
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Address Line | 5300 TOWN AND COUNTRY BLVD SUITE 260
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City | FRISCO
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State | TX
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Zip | 75034-6894
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Country | US
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Telephone | 469-320-9820
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CARRIE E DE MOOR
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Credential | MD
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Telephone | 469-320-9820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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