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General NPI Number Information
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NPI Number | 1629321302
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Entity Type | Organization
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Legal Business Name | CAROLYN B PACE MD PC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 2600 E SOUTHERN AVE SUITE K
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City | TEMPE
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State | AZ
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Zip | 85282-7610
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Country | US
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Telephone | 480-456-6561
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Fax | 480-491-3500
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Provider Business Mailing Address
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Address Line | 2600 E SOUTHERN AVE SUITE K
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City | TEMPE
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State | AZ
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Zip | 85282-7610
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Country | US
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Telephone | 480-456-6561
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Fax | 480-491-3500
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CAROLYN PACE
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Credential | M.D.
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Telephone | 480-456-6561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 22677
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License Number State | AZ
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