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General NPI Number Information
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NPI Number | 1659442028
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Entity Type | Individual
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Provider Name | JOHN DEMORLIS MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HIGHWAY 72 N BLDG # 1
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City | SALEM
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State | MO
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Zip | 65560-0678
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Country | US
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Telephone | 573-729-3410
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Fax | 573-729-6526
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Provider Business Mailing Address
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Address Line | PO BOX 678
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City | SALEM
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State | MO
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Zip | 65560-0678
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Country | US
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Telephone | 573-729-4310
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Fax | 573-729-6526
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R2C15
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License Number State | MO
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