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General NPI Number Information
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NPI Number | 1477655223
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Entity Type | Individual
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Provider Name | MICHAEL ROOS PA
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1420 E CALVADA BLVD STE 100
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City | PAHRUMP
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State | NV
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Zip | 89048-3975
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Country | US
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Telephone | 775-727-0900
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Fax | 702-727-0902
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Provider Business Mailing Address
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Address Line | 1875 S NELLIS BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89104-6215
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Country | US
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Telephone | 702-254-6821
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Fax | 702-243-5012
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 6711
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA0347
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License Number State | NV
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