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General NPI Number Information
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NPI Number | 1790956068
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Entity Type | Organization
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Legal Business Name | RAJAN KHANNA MD APMC
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 1801 FAIRFIELD AVE SUITE 303
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City | SHREVEPORT
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State | LA
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Zip | 71101-4443
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Country | US
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Telephone | 318-841-7932
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6953
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City | SHREVEPORT
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State | LA
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Zip | 71136-6953
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Country | US
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Telephone | 318-841-7932
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Fax |
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Authorized Official
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Title or Position | BILLING CLERK
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Name | LOU A SIMS
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Credential |
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Telephone | 318-671-1745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L11987R
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License Number State | LA
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