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General NPI Number Information
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NPI Number | 1528247277
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Entity Type | Organization
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Legal Business Name | E. CLYDE SMOOT, M.D.-LLC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 4150 NELSON RD BLDG A STE 2
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4148
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Country | US
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Telephone | 337-478-5577
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Fax | 337-478-5588
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Provider Business Mailing Address
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Address Line | 4150 NELSON RD BLDG A STE 2
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4148
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Country | US
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Telephone | 337-478-5577
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Fax | 337-478-5588
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Authorized Official
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Title or Position | OWNER
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Name | ERNEST CLYDE SMOOT
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Credential | M.D.
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Telephone | 337-478-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | MD12854R
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License Number State | LA
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