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General NPI Number Information
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NPI Number | 1427309293
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Entity Type | Organization
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Legal Business Name | MMC DOC MD LLC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 13216 N PLAZA DEL RIO BLVD
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City | PEORIA
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State | AZ
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Zip | 85381-4907
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Country | US
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Telephone | 623-977-5003
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Fax |
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Provider Business Mailing Address
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Address Line | 7298 W AVENIDA DEL SOL
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City | PEORIA
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State | AZ
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Zip | 85383-3257
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Country | US
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Telephone | 623-341-6539
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Fax | 708-801-7128
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Authorized Official
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Title or Position | OWNER
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Name | SRINIVASA REDDY
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Credential | MD
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Telephone | 623-341-6539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 34403
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License Number State | AZ
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