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General NPI Number Information
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NPI Number | 1851478481
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Entity Type | Individual
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Provider Name | MICHAEL REYNARD MD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 1301 20TH ST STE 260
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City | SANTA MONICA
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State | CA
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Zip | 90404-2052
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Country | US
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Telephone | 310-453-0551
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Fax | 310-315-0133
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Provider Business Mailing Address
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Address Line | 1301 20TH ST STE 260
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City | SANTA MONICA
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State | CA
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Zip | 90404-2052
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Country | US
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Telephone | 310-453-0551
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Fax | 310-315-0133
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G40986
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License Number State | CA
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