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General NPI Number Information
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NPI Number | 1366765273
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Entity Type | Organization
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Legal Business Name | MITCHELL F KEAMY III MD PC
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Dates
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Enumeration Date | 03/05/2010
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 1710 WALDMAN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89102-2451
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Country | US
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Telephone | 702-612-7125
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Fax | 702-383-0773
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Provider Business Mailing Address
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Address Line | PO BOX 33121
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City | LAS VEGAS
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State | NV
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Zip | 89133-3121
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Country | US
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Telephone | 702-612-7125
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Fax | 702-383-0773
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JUDY V SMITH
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Credential |
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Telephone | 702-395-1872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 5653
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5653
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License Number State | NV
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