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General NPI Number Information
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NPI Number | 1588162911
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Entity Type | Organization
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Legal Business Name | DESERT EDGE MEDICAL
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 1664 S DIXIE DR STE D201
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City | ST GEORGE
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State | UT
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Zip | 84770
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Country | US
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Telephone | 435-656-2995
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Fax |
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Provider Business Mailing Address
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Address Line | 93 W ORCHARD LN
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City | WASHINGTON
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State | UT
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Zip | 84780-2072
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Country | US
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Telephone | 435-862-5925
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN T BORROWMAN
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Credential | DNP
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Telephone | 435-656-2995
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | UT
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