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General NPI Number Information
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NPI Number | 1376552000
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Entity Type | Organization
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Legal Business Name | COLORADO LASER AND VEIN PC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 8120 S HOLLY ST SUITE 111
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City | CENTENNIAL
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State | CO
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Zip | 80122-4005
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Country | US
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Telephone | 303-741-4060
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Fax | 720-489-6047
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Provider Business Mailing Address
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Address Line | 8120 S HOLLY ST SUITE 111
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City | CENTENNIAL
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State | CO
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Zip | 80122-4005
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Country | US
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Telephone | 303-741-4060
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Fax | 720-489-6047
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Authorized Official
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Title or Position | OWNER
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Name | DAVID SIROOSPOUR
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Credential | M.D.
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Telephone | 303-741-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 37416
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License Number State | CO
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