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General NPI Number Information
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NPI Number | 1518961580
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Entity Type | Individual
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Provider Name | JOHN KENNETH PHILLIPS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 3024 STADIUM BLVD
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City | JONESBORO
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State | AR
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Zip | 72401-7415
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Country | US
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Telephone | 870-934-5113
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Fax | 870-392-3608
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Provider Business Mailing Address
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Address Line | PO BOX 1960 PO BOX 1960
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City | JONESBORO
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State | AR
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Zip | 72403-1960
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Country | US
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Telephone | 870-936-8000
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Fax | 870-936-1043
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | E0129
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License Number State | AR
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