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General NPI Number Information
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NPI Number | 1679570832
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Entity Type | Individual
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Provider Name | MARK M. MEDEIROS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2005
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 10210 N 92ND ST SUITE 305
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4509
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Country | US
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Telephone | 480-551-6979
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Fax | 480-551-9725
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Provider Business Mailing Address
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Address Line | 10210 N 92ND ST SUITE 305
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4509
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Country | US
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Telephone | 480-551-6979
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Fax | 480-551-9725
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18965
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License Number State | AZ
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