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General NPI Number Information
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NPI Number | 1982271599
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Entity Type | Organization
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Legal Business Name | MATTHEW LOUIS MD INC
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 39000 BOB HOPE DR. BANNAN BLDG - STE # 1109
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270
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Country | US
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Telephone | 760-834-3790
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Fax | 760-834-3791
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Provider Business Mailing Address
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Address Line | 255 E AVENIDA GRANADA UNIT 922
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City | PALM SPRINGS
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State | CA
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Zip | 92264-0438
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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 | AUTHORIZED OFFICIAL
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Name | PHILLIS MCCULLON
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Credential |
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Telephone | 760-861-4966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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