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General NPI Number Information
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NPI Number | 1538103197
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Entity Type | Individual
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Provider Name | JOEL WILLIAM SIEVERS MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 304 S MAIN AVE
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City | PORTALES
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State | NM
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Zip | 88130-6218
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Country | US
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Telephone | 575-226-3023
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Fax | 575-226-3024
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | PORTALES
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State | NM
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Zip | 88130-0055
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Country | US
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Telephone | 575-226-3023
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Fax | 575-226-3024
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2002-0109
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License Number State | NM
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