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General NPI Number Information
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NPI Number | 1962837690
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Entity Type | Individual
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Provider Name | CHRISTOPHER HEASLIP
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Gender | Male
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 23160 FASHION DR STE 217
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City | ESTERO
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State | FL
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Zip | 33928-2559
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Country | US
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Telephone | 239-676-2304
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Fax | 239-676-2344
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Provider Business Mailing Address
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Address Line | 23160 FASHION DR STE 217
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City | ESTERO
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State | FL
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Zip | 33928-2559
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Country | US
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Telephone | 239-676-2304
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Fax | 239-676-2344
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | A114970
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License Number State | FL
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