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General NPI Number Information
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NPI Number | 1922132901
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Entity Type | Organization
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Legal Business Name | SHOW LOW NEUROLOGY CLINIC PC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 5171 CUB LAKE RD BLDG C SUITE 340
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City | SHOW LOW
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State | AZ
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Zip | 85901-7888
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Country | US
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Telephone | 928-532-2242
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Fax | 928-532-3006
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Provider Business Mailing Address
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Address Line | PO BOX 1149
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City | LAKESIDE
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State | AZ
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Zip | 85929-1149
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Country | US
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Telephone | 928-532-2242
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Fax | 928-532-3006
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Authorized Official
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Title or Position | PROPRIETOR
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Name | SAM HOCHANE
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Credential | MD
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Telephone | 928-532-2242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 32092
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License Number State | AZ
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