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General NPI Number Information
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NPI Number | 1417448507
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Entity Type | Individual
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Provider Name | ADON HARRIS MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2016 S MAIN ST
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City | MARYVILLE
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State | MO
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Zip | 64468-2655
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Country | US
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Telephone | 660-562-7999
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Fax | 660-562-7996
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Provider Business Mailing Address
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Address Line | 4500 CASS AVE APT 913
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City | DETROIT
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State | MI
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Zip | 48201-1286
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Country | US
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Telephone | 316-209-1654
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2024032663
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301115278
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License Number State | MI
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