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General NPI Number Information
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NPI Number | 1790758613
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Entity Type | Individual
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Provider Name | BENJAMIN STUART WILBUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 1155 NORTH VERMONT AVE SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90029-1728
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Country | US
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Telephone | 323-664-1814
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Fax | 323-663-1723
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Provider Business Mailing Address
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Address Line | 12762 LIMONITE AVE #3E-235
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City | EASTVALE
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State | CA
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Zip | 92880-4208
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Country | US
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Telephone | 951-427-0001
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Fax | 909-483-1063
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A92956
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License Number State | CA
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