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General NPI Number Information
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NPI Number | 1801161138
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Entity Type | Organization
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Legal Business Name | DR KEITH DISMUKES L.L.C.
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 202 US HIGHWAY 80 E
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City | DEMOPOLIS
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State | AL
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Zip | 36732-3622
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Country | US
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Telephone | 334-289-0499
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Fax | 334-289-3013
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Provider Business Mailing Address
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Address Line | PO BOX 650 P.O. BOX 650
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City | DEMOPOLIS
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State | AL
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Zip | 36732-0650
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Country | US
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Telephone | 334-289-0499
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Fax | 334-289-3013
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Authorized Official
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Title or Position | ASST. OFFICE MANAGER
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Name | MRS. LAURI ANNE CAMERON
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Credential | RN
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Telephone | 334-287-2584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AD7121724
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License Number State | AL
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