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General NPI Number Information
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NPI Number | 1629456207
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Entity Type | Individual
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Provider Name | COLTON DANIEL MOJESKY
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Gender | Male
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 4960 NORTON HEALTHCARE BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40241-2831
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Country | US
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Telephone | 859-516-1994
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Fax |
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Provider Business Mailing Address
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Address Line | 479 LAKETOWER DR APT 307
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City | LEXINGTON
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State | KY
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Zip | 40502-2666
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Country | US
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Telephone | 859-516-1994
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 210168
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License Number State | NC
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