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General NPI Number Information
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NPI Number | 1659746535
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Entity Type | Organization
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Legal Business Name | LMD PATH, INC
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 1018 S 350 E
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City | PROVO
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State | UT
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Zip | 84606-6152
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Country | US
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Telephone | 844-987-2267
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Fax | 844-266-9834
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Provider Business Mailing Address
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Address Line | PO BOX 143
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City | PROVO
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State | UT
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Zip | 84603-0143
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Country | US
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Telephone | 844-987-2267
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Fax | 844-266-9834
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | MR. JIM DOUGLAS
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Credential | CPA
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Telephone | 844-987-2267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 52983651205
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License Number State | UT
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