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General NPI Number Information
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NPI Number | 1972719011
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Entity Type | Individual
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Provider Name | JOHN PETER SEIBYL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 60 TEMPLE ST SUITE 8B
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City | NEW HAVEN
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State | CT
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Zip | 06510-2716
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Country | US
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Telephone | 203-401-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 14 WILFORD AVE
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City | BRANFORD
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State | CT
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Zip | 06405-3823
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Country | US
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Telephone | 203-488-7982
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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 | 2084D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
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License Number | 029212
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License Number State | CT
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