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General NPI Number Information
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NPI Number | 1881750610
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY VEIN AND LASER INSTITUTE LLC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 4045 E BELL RD SUITE 119
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City | PHOENIX
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State | AZ
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Zip | 85032-2236
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Country | US
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Telephone | 602-971-2873
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Fax | 602-971-0016
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Provider Business Mailing Address
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Address Line | 4045 E BELL RD SUITE 119
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City | PHOENIX
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State | AZ
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Zip | 85032-2236
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Country | US
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Telephone | 602-971-2873
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Fax | 602-971-0016
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARK R ROSENBERG
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Credential | D.O.
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Telephone | 602-971-2873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2245
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License Number State | AZ
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