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General NPI Number Information
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NPI Number | 1922257500
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Entity Type | Individual
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Provider Name | TRAVIS RICHARD SMITH D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-3887
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Fax |
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Provider Business Mailing Address
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Address Line | 4501 LILAC RD
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City | SOUTH EUCLID
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State | OH
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Zip | 44121-3902
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Country | US
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Telephone | 216-382-0436
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | O-1308
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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