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General NPI Number Information
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NPI Number | 1649664301
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Entity Type | Organization
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Legal Business Name | PENINSULA ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 50 S SAN MATEO DR SUITE 400
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City | SAN MATEO
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State | CA
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Zip | 94401-3861
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Country | US
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Telephone | 650-373-1970
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Fax |
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Provider Business Mailing Address
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Address Line | 50 S SAN MATEO DR SUITE 400
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City | SAN MATEO
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State | CA
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Zip | 94401-3861
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Country | US
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Telephone | 650-373-1970
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM D DAVIS
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Credential |
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Telephone | 916-566-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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