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General NPI Number Information
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NPI Number | 1699019869
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Entity Type | Organization
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Legal Business Name | BROOKE K STOUGH DPM
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 11/12/2012
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Provider Practice Location Address
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Address Line | 1113 WINCHESTER AVE
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City | ENID
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State | OK
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Zip | 73703-8401
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Country | US
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Telephone | 405-210-8071
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 WINCHESTER AVE
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City | ENID
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State | OK
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Zip | 73703-8401
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Country | US
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Telephone | 405-210-8071
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Fax |
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Authorized Official
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Title or Position | PODIATRIST/OWNER
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Name | DR. BROOKE KELLEY STOUGH
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Credential | DPM
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Telephone | 405-210-8071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 297
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License Number State | OK
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