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General NPI Number Information
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NPI Number | 1285341834
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Entity Type | Organization
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Legal Business Name | DIRECT MEDICAL XPERIENCE
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4505 FAIR MEADOWS LN STE 215
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City | RALEIGH
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State | NC
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Zip | 27607-6449
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Country | US
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Telephone | 919-944-9935
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Fax |
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Provider Business Mailing Address
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Address Line | 11845 RETAIL DR # 1079
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City | WAKE FOREST
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State | NC
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Zip | 27587-7352
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Country | US
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Telephone | 919-944-9935
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DEAUNDRE ALFONZO DYER
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Credential | D.O.
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Telephone | 919-944-9935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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