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General NPI Number Information
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NPI Number | 1437389277
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Entity Type | Individual
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Provider Name | JESSICA ZARAH SUGIANTO MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 5213 VIRGINIA PKWY
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City | MCKINNEY
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State | TX
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Zip | 75071-5655
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Country | US
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Telephone | 972-390-9002
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Fax | 972-767-4363
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Provider Business Mailing Address
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Address Line | 1790 N STONEBRIDGE DR
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City | MCKINNEY
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State | TX
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Zip | 75071-7437
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Country | US
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Telephone | 972-390-9002
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Fax | 214-491-3777
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | Q5932
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | Q5932
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License Number State | TX
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