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General NPI Number Information
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NPI Number | 1770093650
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Entity Type | Individual
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Provider Name | MATTHEW REGGIO
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Gender | Male
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1 JARRETT WHITE RD
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City | HONOLULU
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State | HI
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Zip | 96259
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Country | US
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Telephone | 808-433-5074
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Fax |
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Provider Business Mailing Address
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Address Line | BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DRIVE
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City | JBSA FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-7741
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 5061101-8901
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License Number State | UT
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