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General NPI Number Information
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NPI Number | 1861516551
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Entity Type | Individual
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Provider Name | LAURIE EDMISTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7777 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75232
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Country | US
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Telephone | 972-566-5544
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Fax | 214-369-5457
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Provider Business Mailing Address
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Address Line | 6206 PRESTONSHIRE LN
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City | DALLAS
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State | TX
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Zip | 75225-2109
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Country | US
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Telephone | 214-891-0511
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Fax | 214-369-5457
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G5015
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License Number State | TX
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