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General NPI Number Information
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NPI Number | 1629304423
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CANCER CARE, PC
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 12855 N 40 DR SUITE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 314-443-6465
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190820
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City | SAINT LOUIS
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State | MO
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Zip | 63119-6820
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Country | US
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Telephone | 314-443-6465
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY M KLIX
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Credential | MD
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Telephone | 314-443-6465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 112773
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License Number State | MO
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