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General NPI Number Information
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NPI Number | 1831170935
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Entity Type | Individual
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Provider Name | KEVIN JOHN HASELHORST MD
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Gender | Male
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 13677 W MCDOWELL RD
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City | GOODYEAR
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State | AZ
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Zip | 85338-2618
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Country | US
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Telephone | 623-882-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 5777 N 78TH PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-6170
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Country | US
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Telephone | 480-947-9682
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25725
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25725
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License Number State | AZ
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