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General NPI Number Information
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NPI Number | 1699901231
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Entity Type | Individual
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Provider Name | DANIEL WILFORD BROADBENT MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 991 SHEPARD LN STE 200
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City | FARMINGTON
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State | UT
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Zip | 84025-2972
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Country | US
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Telephone | 801-397-6080
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Fax | 801-397-6081
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Provider Business Mailing Address
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Address Line | PO BOX 5546
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City | DENVER
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State | CO
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Zip | 80217-5546
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Country | US
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Telephone | 801-397-6080
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Fax | 801-397-6081
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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 | 9314408-1205
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License Number State | UT
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