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General NPI Number Information
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NPI Number | 1821127978
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Entity Type | Organization
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Legal Business Name | BREAST CARE SPECIALISTS AMC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 820 JORDAN ST STE 210
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City | SHREVEPORT
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State | LA
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Zip | 71101-4519
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Country | US
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Telephone | 318-687-7117
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Fax |
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Provider Business Mailing Address
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Address Line | 820 JORDAN ST STE 210
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City | SHREVEPORT
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State | LA
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Zip | 71101-4519
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Country | US
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Telephone | 318-524-9565
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL OFFICER
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Name | CHRISTOPHER S. SOCKRIDER
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Credential | MD
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Telephone | 318-687-7117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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