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General NPI Number Information
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NPI Number | 1629631395
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Entity Type | Individual
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Provider Name | POOJA MYSORE MD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 1050 W GALLERIA DR
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City | HENDERSON
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State | NV
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Zip | 89011-4800
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Country | US
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Telephone | 702-963-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 4471 DEAN MARTIN DR UNIT 3909
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City | LAS VEGAS
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State | NV
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Zip | 89103-4116
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Country | US
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Telephone | 631-833-8616
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 100905
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 100905
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 27240
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License Number State | NV
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