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General NPI Number Information
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NPI Number | 1881821387
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Entity Type | Organization
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Legal Business Name | PURISIMA FAMILY MEDICINE, INC.
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 575 KELLY ST
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City | HALF MOON BAY
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State | CA
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Zip | 94019-1719
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Country | US
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Telephone | 650-288-0508
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Fax | 650-713-0535
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Provider Business Mailing Address
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Address Line | PO BOX 277
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City | HALF MOON BAY
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State | CA
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Zip | 94019-0277
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Country | US
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Telephone | 650-288-0508
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Fax | 650-713-0535
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL EUGENE MCMILLAN
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Credential | M.D.
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Telephone | 650-288-0508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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