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General NPI Number Information
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NPI Number | 1902119902
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Entity Type | Individual
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Provider Name | STACI BOGIN DPM
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Gender | Female
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 3655 E 104TH AVE SUITE B
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City | THORNTON
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State | CO
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Zip | 80233-4469
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Country | US
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Telephone | 720-328-2022
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Fax | 720-328-1224
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Provider Business Mailing Address
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Address Line | 3879 E 120TH AVE #337
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City | THORNTON
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State | CO
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Zip | 80233-1658
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Country | US
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Telephone | 720-328-2022
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Fax | 720-328-1224
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD-698
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License Number State | CO
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