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Individual
JACK SAILOR
Active
Individual
JACK SAILOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
P059173009
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P059173009
CERTIFIED ATHLETIC TRAINER
MO
Enumeration date
10/10/2014
Last updated
10/10/2014
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