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General NPI Number Information
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NPI Number | 1558603969
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Entity Type | Individual
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Provider Name | BRUCE STUART ALLEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2013
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Last Update Date | 03/24/2013
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Provider Practice Location Address
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Address Line | 1338 OLD FORSYTH RD
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City | MACON
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State | GA
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Zip | 31210-7205
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Country | US
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Telephone | 478-471-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 1338 OLD FORSYTH RD
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City | MACON
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State | GA
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Zip | 31210-7205
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Country | US
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Telephone | 478-471-7788
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 20294
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License Number State | GA
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