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General NPI Number Information
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NPI Number | 1952380743
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Entity Type | Individual
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Provider Name | PAUL A SMUCKER MD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 53880 CARMICHAEL DR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1567
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Country | US
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Telephone | 574-247-9441
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Fax | 574-247-9442
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Provider Business Mailing Address
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Address Line | 3600 W BETHEL AVE
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City | MUNCIE
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State | IN
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Zip | 47304-5407
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Country | US
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Telephone |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036085527
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 01040699A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 01040699A
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License Number State | IN
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