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General NPI Number Information
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NPI Number | 1740418409
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Entity Type | Individual
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Provider Name | MIKE A ROYAL MD JD MBA
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Gender | Male
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 12481 HIGH BLUFF DR SUITE 200
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City | SAN DIEGO
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State | CA
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Zip | 92130-3585
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Country | US
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Telephone | 858-436-1427
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Fax | 858-436-1401
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Provider Business Mailing Address
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Address Line | 4533 OCEAN VALLEY LN
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City | SAN DIEGO
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State | CA
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Zip | 92130-2428
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Country | US
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Telephone | 858-794-4975
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G86767
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License Number State | CA
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