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General NPI Number Information
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NPI Number | 1972602910
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Entity Type | Individual
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Provider Name | SCOTT E SOUTHWORTH MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 520 MEDICAL DR STE 300
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8925
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Country | US
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Telephone | 801-292-1422
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Fax |
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Provider Business Mailing Address
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Address Line | 140 N UNION AVE STE F-300
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City | FARMINGTON
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State | UT
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Zip | 84025-2953
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Country | US
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Telephone | 801-294-9333
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 173151-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 173151-1205
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License Number State | UT
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