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General NPI Number Information
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NPI Number | 1689126849
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Entity Type | Individual
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Provider Name | MR. DAVID MICHAEL GEORGE
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Gender | Male
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 134 ENCHANTED PKWY SUITE 203
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City | MANCHESTER
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State | MO
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Zip | 63021-5495
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Country | US
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Telephone | 636-220-3090
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Fax | 888-439-4702
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Provider Business Mailing Address
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Address Line | 1852 WINEGARD DR
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City | BALLWIN
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State | MO
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Zip | 63021-5837
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Country | US
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Telephone | 636-220-3090
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Fax | 888-439-4702
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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