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General NPI Number Information
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NPI Number | 1629280995
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Entity Type | Individual
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Provider Name | REEDADA S IDRISS MD
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 24 HOSPITAL AVE
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City | DANBURY
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State | CT
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Zip | 06810-6099
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Country | US
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Telephone | 203-739-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 5120 DUVALL PL NW
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City | ROCHESTER
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State | MN
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Zip | 55901-3821
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Country | US
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Telephone | 507-287-1831
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 49753
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 047400
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License Number State | CT
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