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General NPI Number Information
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NPI Number | 1467082438
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Entity Type | Organization
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Legal Business Name | PROLIFERATIVEMED PLLC
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Dates
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Enumeration Date | 01/18/2020
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Last Update Date | 01/18/2020
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Provider Practice Location Address
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Address Line | 731 E SOUTHLAKE BLVD STE 110
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6378
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Country | US
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Telephone | 817-917-6197
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Fax |
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Provider Business Mailing Address
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Address Line | 615 W LAMAR ST
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City | MCKINNEY
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State | TX
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Zip | 75069-3848
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Country | US
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Telephone | 817-917-6197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN B. SANDERS
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Credential | MD
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Telephone | 972-839-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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