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Please complete to join the employer platform. PROVIDER Profile
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* Indicates required question
Email address
*
Your answer
Practice Name
Your answer
Physician Name
Your answer
Physician NPI
Your answer
Address with city and state
Your answer
Phone
Your answer
Pure Dpc
Yes
No
Clear selection
Hybrid (meaning you file any type of insurance)
Yes
No
Clear selection
Contact person & email for the person in your practice that will follow up with the employee that selects your clinic
Your answer
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