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General NPI Number Information
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NPI Number | 1508030107
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Entity Type | Organization
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Legal Business Name | DAVID L. FOGELSON, M.D., INC.
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 2730 WILSHIRE BLVD SUITE 325
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City | SANTA MONICA
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State | CA
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Zip | 90403-4743
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Country | US
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Telephone | 310-828-5015
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Fax | 310-829-3877
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Provider Business Mailing Address
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Address Line | 2730 WILSHIRE BLVD SUITE 325
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City | SANTA MONICA
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State | CA
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Zip | 90403-4743
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID LESLIE FOGELSON
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Credential |
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Telephone | 310-828-5015
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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 | G39149
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License Number State | CA
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