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General NPI Number Information
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NPI Number | 1801032925
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Entity Type | Organization
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Legal Business Name | PAUL SIMON DO LLC
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 255 SPENCER RD SUITE 201
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City | SAINT PETERS
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State | MO
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Zip | 63376-2494
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Country | US
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Telephone | 636-939-2550
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Fax | 636-939-2551
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Provider Business Mailing Address
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Address Line | 255 SPENCER RD SUITE 201
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City | SAINT PETERS
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State | MO
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Zip | 63376-2494
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Country | US
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Telephone | 636-939-2550
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Fax | 636-939-2551
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR OF OPERATIONS
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Name | KIM STELZER
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Credential |
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Telephone | 636-939-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2007003913
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License Number State | MO
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