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General NPI Number Information
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NPI Number | 1720360795
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Entity Type | Organization
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Legal Business Name | MINDEN PHYSICIAN PRACTICES LLC
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 427 HOMER RD
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City | MINDEN
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State | LA
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Zip | 71055-2933
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Country | US
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Telephone | 318-377-8855
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Fax | 318-371-1170
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Provider Business Mailing Address
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Address Line | 504 TEXAS ST STE 200
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City | SHREVEPORT
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State | LA
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Zip | 71101-3526
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Country | US
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Telephone | 318-226-8202
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Fax | 318-377-8852
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHANNON DAWN BROWN
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Credential |
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Telephone | 318-382-7296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 118
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License Number State | LA
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