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General NPI Number Information
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NPI Number | 1629153705
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Entity Type | Organization
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Legal Business Name | EUGENE GILES SR MD PSC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 2746 VIRGINIA AVE
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City | LOUISVILLE
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State | KY
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Zip | 40211-3417
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Country | US
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Telephone | 502-776-1177
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Fax | 502-772-1761
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Provider Business Mailing Address
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Address Line | 2746 VIRGINIA AVE
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City | LOUISVILLE
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State | KY
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Zip | 40211-3417
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Country | US
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Telephone | 502-776-1177
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Fax | 502-772-1761
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Authorized Official
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Title or Position | SOLO MEMBER OWNER
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Name | EUGENE GILES SR.
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Credential | MD
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Telephone | 502-776-1177
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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 | 22657
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 22657
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License Number State | KY
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