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General NPI Number Information
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NPI Number | 1629382957
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Entity Type | Individual
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Provider Name | FRED EUGENE KASPER IDC
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Gender | Male
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 5501 MARVIN SHIELDS BLVD
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City | GULFPORT
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State | MS
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Zip | 39501-9007
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Country | US
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Telephone | 228-822-5748
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 LYNN AVE
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City | GULFPORT
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State | MS
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Zip | 39503-3644
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Country | US
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Telephone | 228-206-4918
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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