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General NPI Number Information
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NPI Number | 1447200464
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Entity Type | Individual
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Provider Name | DR. FIDEL DELEON MAKAPUGAY
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 491 W POPLAR AVE
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City | COLLIERVILLE
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State | TN
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Zip | 38017-2537
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Country | US
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Telephone | 901-850-9900
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Fax | 901-853-2706
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Provider Business Mailing Address
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Address Line | 491 W POPLAR AVE
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City | COLLIERVILLE
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State | TN
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Zip | 38017-2537
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Country | US
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Telephone | 901-850-9900
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Fax | 901-853-2706
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD0000021004
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License Number State | TN
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