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General NPI Number Information
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NPI Number | 1366794919
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Entity Type | Organization
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Legal Business Name | DESERT MOUNTAIN FAMILY MEDICINE P.C.
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Dates
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Enumeration Date | 10/06/2012
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Last Update Date | 10/06/2012
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Provider Practice Location Address
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Address Line | 8428 E SHEA BLVD SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6663
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Country | US
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Telephone | 480-451-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 11866 E MISSION LN
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5943
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Country | US
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Telephone | 480-695-3429
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | VICKI L LUGO
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Credential |
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Telephone | 480-451-9191
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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 | 21128
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License Number State | AZ
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