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General NPI Number Information
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NPI Number | 1669592796
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Entity Type | Individual
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Provider Name | CHRISTOPHER J DEPORTER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1800 MCFARLAND BLVD N SUITE 220
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2114
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Country | US
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Telephone | 205-759-2851
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Fax |
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Provider Business Mailing Address
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Address Line | 4205 CLEAR CREEK PKWY
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City | NORTHPORT
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State | AL
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Zip | 35475-4436
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Country | US
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Telephone | 205-333-5318
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 143
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License Number State | AL
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