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General NPI Number Information
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NPI Number | 1467508713
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Entity Type | Individual
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Provider Name | GOLAM S. CHOUDHURY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 3121 S MARYLAND PKWY SUITE 414
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City | LAS VEGAS
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State | NV
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Zip | 89109-2307
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Country | US
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Telephone | 702-731-5113
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Fax | 702-734-8381
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Provider Business Mailing Address
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Address Line | PO BOX 96475
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City | LAS VEGAS
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State | NV
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Zip | 89193-6475
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Country | US
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Telephone | 702-731-5113
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Fax | 702-734-8381
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 3742
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License Number State | NV
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