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Microsoft Word - SAMPLE Individual Attestation BOARD CERT.doc
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Document Date: 2013-04-29 10:45:19
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File Size: 38,40 KB
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City
Provider /
/
Person
Mark Jones /
/
Position
eligible physician and the eligible physician /
Eligible/Supervising Physician Information Name /
sub specialist /
Physician /
care physician /
Eligible Physician /
Family Medicine General /
Eligible/Supervising Physician /
/
SocialTag
Specialty
Medicaid
Physician
Family medicine
American Board of Medical Specialties
Medicine
Medical specialties
Board certification