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General NPI Number Information
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NPI Number | 1366543365
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Entity Type | Organization
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Legal Business Name | COLGLAZIER CLINIC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 945 WASHINGTON AVENUE
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City | GRANT
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State | NE
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Zip | 69140-0097
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Country | US
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Telephone | 308-352-2122
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Fax | 308-352-2281
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Provider Business Mailing Address
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Address Line | 945 WASHINGTON AVENUE PO BOX 97
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City | GRANT
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State | NE
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Zip | 69140-0097
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Country | US
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Telephone | 308-352-2122
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Fax | 308-352-2281
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLIFFORD R. COLGLAZIER
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Credential | M.D.
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Telephone | 308-352-2122
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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 | 14390
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License Number State | NE
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