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General NPI Number Information
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NPI Number | 1750444634
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Entity Type | Organization
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Legal Business Name | HEBRON FAMILY PHYSICIANS LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 23 A LIBERTY DRIVE
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City | HEBRON
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State | CT
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Zip | 06248
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Country | US
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Telephone | 860-228-1119
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Fax | 860-228-4314
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Provider Business Mailing Address
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Address Line | PO BOX 636
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City | HEBRON
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State | CT
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Zip | 06248
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Country | US
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Telephone | 860-228-1119
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Fax | 860-228-4314
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Authorized Official
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Title or Position | MD
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Name | DR. KRISTIN STANLEY GILDERSLEEVE
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Credential | MD
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Telephone | 860-228-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 038237
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License Number State | CT
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