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General NPI Number Information
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NPI Number | 1700908241
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Entity Type | Individual
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Provider Name | EDDIE M SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 103 PICCIOLA PKWY
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City | CUT OFF
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State | LA
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Zip | 70345-3572
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Country | US
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Telephone | 985-325-6226
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Fax | 982-325-6242
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Provider Business Mailing Address
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Address Line | PO BOX 457
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City | GOLDEN MEADOW
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State | LA
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Zip | 70357-0457
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Country | US
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Telephone | 985-325-6226
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Fax | 985-325-6242
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 18307
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License Number State | LA
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