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General NPI Number Information
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NPI Number | 1881044006
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Entity Type | Individual
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Provider Name | TRISTAN ROSS PEREGRINO FOWLER DO
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Gender | Male
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Dates
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Enumeration Date | 06/18/2016
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1013 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5043
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Country | US
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Telephone | 573-472-7535
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Fax | 573-472-7787
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Provider Business Mailing Address
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Address Line | 1013 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5043
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Country | US
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Telephone | 573-472-7535
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Fax | 573-472-7787
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 05-43441
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5101022338
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License Number State | MI
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