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General NPI Number Information
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NPI Number | 1962537233
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Entity Type | Organization
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Legal Business Name | HARJIT SUD M.D&THOMAS T. STREETER M.D. PROFESSIONAL CORP
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 2509 W MARCH LN SUITE 250
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City | STOCKTON
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State | CA
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Zip | 95207-8252
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Country | US
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Telephone | 209-957-1000
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Fax | 209-957-1001
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Provider Business Mailing Address
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Address Line | 2509 W MARCH LN STE.250
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City | STOCKTON
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State | CA
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Zip | 95207-8252
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Country | US
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Telephone | 209-957-1000
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Fax | 209-957-1001
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Authorized Official
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Title or Position | MANAGER
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Name | MS. KATHLEEN EDWARDS
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Credential |
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Telephone | 209-957-1000
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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 |
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License Number State |
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