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General NPI Number Information
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NPI Number | 1720069982
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Entity Type | Individual
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Provider Name | MICHAEL JAMES STAGNER MD
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Gender | Male
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 40 CAPRI BLVD STE 102
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5661
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Country | US
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Telephone | 928-855-9477
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Fax | 928-855-2983
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Provider Business Mailing Address
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Address Line | 4800 N 22ND ST STE 210
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City | PHOENIX
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State | AZ
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Zip | 85016-4963
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Country | US
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Telephone | 602-955-1000
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Fax | 602-508-4830
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 24627
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License Number State | AZ
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