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General NPI Number Information
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NPI Number | 1457580565
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Entity Type | Individual
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Provider Name | SAMUEL B CLINCH MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 340 E 1ST AVE STE 333
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City | BROOMFIELD
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State | CO
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Zip | 80020-2454
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Country | US
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Telephone | 720-446-8675
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Fax | 720-798-6969
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Provider Business Mailing Address
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Address Line | 340 E 1ST AVE STE 333
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City | BROOMFIELD
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State | CO
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Zip | 80020-2454
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Country | US
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Telephone | 720-446-8675
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Fax | 720-798-6969
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0052292
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License Number State | CO
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