NPI
First Name
Middle Name
Last Name
Name Prefix
Name Suffix
Credential
Gender
Mailing Address1
Mailing Address2
Mailing City
Mailing State
Mailing Zip Code
Mailing Phone
Mailing Fax
Business Address 1
Business Address 2
Business City
Business State
Business Zip Code
Business Phone
Telephone Number
Business Fax
Type
Classification
Specialization
License Number
License Number State
Creation Date
Last Update Date
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