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Tax ID: 202874196 NPI: 1457428005

Health Insurance Plan Provider Number Effective Date
Aetna 7092883 4/1/07
AvMed 202348 6/15/07
BCBS (HMO,PPO, FED) 60P 4/1/07
BCBS Medicare Product 60P 4/15/08
Cigna 202874196 11/19/07
Freedom Health 202874196 6/1/08
Great West 202874196 5/1/07

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