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General NPI Number Information
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NPI Number | 1285902106
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Entity Type | Organization
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Legal Business Name | WARREN KEITH STAFFORD, M.D.
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 206A S MAIN ST
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City | GREER
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State | SC
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Zip | 29650-2127
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Country | US
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Telephone | 864-989-0230
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Fax | 864-334-1880
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Provider Business Mailing Address
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Address Line | 8055 WERTMAN RD
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City | FOGELSVILLE
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State | PA
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Zip | 18051-1820
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Country | US
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Telephone | 484-553-3286
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Fax | 484-214-0347
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | BRENDA KLINGER
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Credential |
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Telephone | 484-553-3286
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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 | 23690
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License Number State | SC
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