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General NPI Number Information
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NPI Number | 1477603587
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Entity Type | Organization
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Legal Business Name | MORRIS E. GALES III MD
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 29556 SOUTHFIELD RD SUITE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2021
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Country | US
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Telephone | 248-423-1550
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Fax | 248-423-1552
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Provider Business Mailing Address
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Address Line | 29556 SOUTHFIELD RD SUITE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2021
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Country | US
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Telephone | 248-423-1550
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Fax | 248-423-1552
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MORRIS EDWARD GALES III
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Credential | MD,FCCWS
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Telephone | 248-423-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704114991
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704207635
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301049444
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License Number State | MI
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