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General NPI Number Information
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NPI Number | 1710563259
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Entity Type | Individual
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Provider Name | JOSHUA MICHAEL SPORE DO
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1125 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1908
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Country | US
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Telephone | 479-521-8260
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 800-893-9698
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | E-16228
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-16228
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License Number State | AR
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