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General NPI Number Information
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NPI Number | 1508098948
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Entity Type | Individual
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Provider Name | MATTHEW J. STEPHENS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2009
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 1400 JACKSON ST
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City | DENVER
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State | CO
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Zip | 80206-2761
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Country | US
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Telephone | 303-388-4461
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Fax | 303-270-2206
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Provider Business Mailing Address
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Address Line | PO BOX 636256 CENTRAL CREDENTIALING
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City | CINCINNATI
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State | OH
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Zip | 45263-6256
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Country | US
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Telephone | 513-245-3107
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Fax | 513-585-5511
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01068794A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 54455
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License Number State | CO
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