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General NPI Number Information
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NPI Number | 1548261712
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Entity Type | Organization
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Legal Business Name | NEUROMEDICINE CENTER, PLLC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1520 S DOBSON RD SUITE 213A
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City | MESA
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State | AZ
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Zip | 85202-4725
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Country | US
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Telephone | 480-615-7800
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Fax | 480-615-7803
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Provider Business Mailing Address
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Address Line | 1520 S DOBSON RD SUITE 213A
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City | MESA
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State | AZ
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Zip | 85202-4725
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Country | US
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Telephone | 480-615-7800
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Fax | 480-615-7803
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JAYANTIBHAI PATEL
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Credential | M.D.
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Telephone | 480-615-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28930
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 30177
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License Number State | AZ
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