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General NPI Number Information
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NPI Number | 1912977992
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Entity Type | Individual
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Provider Name | ANDREW POULOS MD
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Gender | Male
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 15810 S 45TH ST STE 110
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City | PHOENIX
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State | AZ
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Zip | 85048-7695
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Country | US
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Telephone | 480-763-7273
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Fax |
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Provider Business Mailing Address
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Address Line | 7416 E PALO VERDE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-6030
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Country | US
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Telephone | 480-888-6248
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 15512
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License Number State | AZ
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