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K. Medical School:
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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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MASTER_ID
Medical/Dental School Name:
Internship:
Residency:
Fellowship:
Teaching:
Street Address/PO Box:
Street Address Continued:
CITY
State/Province:
Country:
Postal Zip Code:
Telephone Number:
Facsimile Number:
Email Address:
Attended From:
Attended To:
Graudation Date:
Medial/Dental Degree Date:
Speciality:
Are of Field of Study:
Depart_Spec?
Director's Name:
Other:
tim2
University Medical School
1
1
1
1
1919 S. University Blvd
Denver
Co
USA
80010
303.779.4568
720345837799
registar@universityMedSch.com
09/04/2001
05/23/2003
06/19/2003
06/26/2003
Health
Diet
tim2
Boston Med
Yes
No
No
No
23442 North St
Boston
Ma.
US
23432
123 413 1234
`
01/13/2009
01/12/2010
01/04/2011
01/18/2012
tim2
Boston Medical School
no
yes
No
No
23442 North St
kghgjkj
Boston
Ma
US
23432
123 413 1234
`
01/13/2009
01/12/2010
01/04/2011
01/18/2012
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