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General NPI Number Information
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NPI Number | 1295127215
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Entity Type | Individual
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Provider Name | MR. PERCY CALVERT III
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Gender | Male
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 10400 VINEYARD BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-3829
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Country | US
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Telephone | 405-521-1755
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Fax |
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Provider Business Mailing Address
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Address Line | 8111 E 93RD ST APT 2211
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City | TULSA
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State | OK
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Zip | 74133-5540
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Country | US
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Telephone |
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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