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General NPI Number Information
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NPI Number | 1649500877
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Entity Type | Organization
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Legal Business Name | REDIMEDIC INC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 3418 LOMA VISTA RD SUITE B
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City | VENTURA
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State | CA
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Zip | 93003-3016
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Country | US
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Telephone | 805-644-4809
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Fax | 805-654-7090
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Provider Business Mailing Address
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Address Line | 3418 LOMA VISTA RD SUITE B
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City | VENTURA
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State | CA
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Zip | 93003-3016
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Country | US
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Telephone | 805-644-4809
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Fax | 805-654-7090
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEPHEN ROBERT SHAW
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Credential | MD
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Telephone | 805-644-4809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G47926
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License Number State | CA
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