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General NPI Number Information
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NPI Number | 1629081195
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Entity Type | Individual
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Provider Name | LESLIE A. KONKIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 04/05/2020
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Provider Practice Location Address
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Address Line | 1501 OAKDALE RD STE 301
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City | MODESTO
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State | CA
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Zip | 95355-3382
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Country | US
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Telephone | 209-571-5071
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Fax | 209-577-1157
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Provider Business Mailing Address
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Address Line | PO BOX 576158
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City | MODESTO
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State | CA
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Zip | 95357-6158
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Country | US
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Telephone | 209-605-6469
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G24534
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License Number State | CA
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