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General NPI Number Information
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NPI Number | 1295050037
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Entity Type | Individual
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Provider Name | LIJO JOHN MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 1300 N 4TH ST
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City | LONGVIEW
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State | TX
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Zip | 75601-4717
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Country | US
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Telephone | 903-757-2122
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Fax | 903-757-9475
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Provider Business Mailing Address
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Address Line | PO BOX 911230
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City | DALLAS
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State | TX
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Zip | 75391-1230
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Country | US
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Telephone | 972-997-8000
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Fax | 972-234-2987
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P7933
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | P7933
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License Number State | TX
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