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General NPI Number Information
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NPI Number | 1598803165
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Entity Type | Individual
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Provider Name | KELLY ANDRE SHARRAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4981 INDIAN PEAK RD
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City | MARIPOSA
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State | CA
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Zip | 95338-9373
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Country | US
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Telephone | 209-742-5977
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Fax | 209-266-1855
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Provider Business Mailing Address
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Address Line | PO BOX 2301
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City | MARIPOSA
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State | CA
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Zip | 95338-2301
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Country | US
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Telephone | 209-682-5228
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Fax | 209-682-5227
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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 | A93376
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License Number State | CA
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