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General NPI Number Information
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NPI Number | 1588635288
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Entity Type | Organization
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Legal Business Name | E L RACEK MD FACS INC
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 750 MEDICAL CENTER COURT #5
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City | CHULA VISTA
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State | CA
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Zip | 91911
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Country | US
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Telephone | 619-482-0082
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Fax |
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Provider Business Mailing Address
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Address Line | 750 MEDICAL CENTER COURT #5
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City | CHULA VISTA
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State | CA
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Zip | 91911
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Country | US
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Telephone | 619-482-0082
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD L. RACEK
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Credential | M.D.
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Telephone | 619-482-0082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 002702-06
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License Number State | CA
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