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J. Group Practice & Employment:
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A. Master Personal Detailed Record:
C. Physical Data:
D. Board Certifications:
F. Medical License/Registrations
G. Hospital Affiliations:
H. Hospital Privileges:
I. Office Addresses:
J. Group Practice & Employment:
K. Medical School:
L. Medical Training:
M. Military Medical Training:
N. Professional Medical References:
O. Professional Associations:
P. Professional Liability Carrier:
Q. Disclosure questions:
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practice_Id
Master_Id
current_former
practice_Name
practice_owner_name
ein_tax_id_num
practice_hours
practice_hours2
practice_24h
practice_24h_phone
practice_street_address
practice_city
practice_state
practice_zip_code
Cred_office_admin
practice_phone_num
practice_office_fax
practice_email_address
date_from
date_to
Reason_for_leaving
Suite_Building
Contact_Last_Name
Contact_First_Name
practice_type
fed_tax_id
Group_Practice_NID
Middle_I
Name_Fed_Tax_id
Answering_Service
Pager_Beeper
Office_Manager_phone
Office_manager_fax
Practice_NPI
Country
Patient_App_Phone
2
tim2
Current
North Centeral Med
Stella M. Parker
45123451234
9 to 5
8 to 12
Yes
234.234.2345
1901 N. Colorado Blvd
Thornton
Co
80233
Stella M. Parker
303 452 8444
720 479 8821
stellamparker@msn.com
03/11/2006
Group/Single Specialty
3616581684651641651
3
tim2
Former
Southern Clinic
Stella M. Parker
234134533
9 to 5 and then some
9-12
Yes
234.234.2345
1901 N. Colorado Blvd.
Thornton
Co
80233
Stella M. Parker
303 452 8444
720 479 8821
stellamparker@msn.com
08/17/1996
09/21/2006
New Clinic
Group/Single Specialty
4
brb1
Current
Test
Test
Test
Test
Test
No
Test
Test
Test
Test
Test
Test
Test
Test
Test
06/06/2007
06/13/2012
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