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General NPI Number Information
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NPI Number | 1659465615
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Entity Type | Individual
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Provider Name | JAMES EARL STANDEFER JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 5 OLD FARM RD SUITE C2
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City | RED HOOK
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State | NY
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Zip | 12571-1643
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Country | US
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Telephone | 845-702-3487
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Fax | 845-520-9169
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Provider Business Mailing Address
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Address Line | PO BOX 4
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City | TIVOLI
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State | NY
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Zip | 12583-0004
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Country | US
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Telephone | 845-757-2160
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 235444-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 235444-1
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License Number State | NY
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