First Name | Middle Name | Last Name | Prefix | Suffix | Birth Date | Gender | Social Security Number | Maiden Name | Alias | Active | Address Type | Address Line1 | Address Line2 | City | State ID | Zip Code | Zip4 Code | County Name | IsPrimary | Latitude | Longitude | IsAddressActive | Phone Type | Phone Number | Extension | IsPrimaryPhone | IsPhoneActive | Created Date | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Devin | Sergio | Gutrerrez | Dr. | IV | 02/05/1987 | M | 900010593 | Sergio | 1 | 2464 Eagle Glenn Cove Lane | Suite 372 | Martinsburg | WV | 25401 | 8555 | Berkeley | 39.44 | -77.95 | 1 | 3046132844 | 9424 | 8/21/2022 9:11:54 AM | Details | ||||||
Michel | Royce | Baenziger | Mr. | IV | 12/07/1970 | M | 900010588 | Royce | 1 | 9047 Spill Way Blvd | Pentress | WV | 26544 | 8638 | Monongalia | 39.58 | -80.09 | 2 | 6813296014 | 8/21/2022 9:11:53 AM | Details | ||||||||
Dong | Edwin | Ouimet | Dr. | IV | 11/07/1971 | M | 900010589 | Edwin | 1 | 8877 55th Blvd | Suite 144 | Chambersburg | IL | 62323 | Pike | 39.78 | -90.75 | 1 | 6186333374 | 7453 | 8/21/2022 9:11:54 AM | Details | |||||||
Cedrick | Erick | Hartley | Mr. | IV | 03/06/1957 | M | 900010667 | Erick | 2 | 9538 North Dauphine St | Shirland | IL | 61079 | 8848 | Winnebago | 42.33 | -89.17 | 2 | 3095480860 | 8/22/2022 1:03:48 PM | Details | ||||||||
Alec | Mohammad | Otake | Mr. | IV | 08/22/1983 | M | 900010669 | Mohammad | 1 | 5650 Bittersweet Lane | Suite 233 | Earlville | PA | 19519 | 9680 | Berks | 40.32 | -75.73 | 1 | 4124238996 | 8/22/2022 1:03:48 PM | Details | |||||||
Lance | Mohamed | Zielonko | Mr. | IV | 05/08/1991 | M | 900010824 | Mohamed | 2 | 2359 Crystal Hill Blvd | Bldg 16 | Beaver | AR | 72613 | 6841 | Carroll | 36.43 | -93.70 | 2 | 5014753241 | 848 | 9/1/2022 3:47:12 AM | Details | ||||||
Nigel | Ian | Lupold | Mr. | IV | 01/14/1963 | M | 900010769 | Ian | 3 | 5395 West Fourth Lane | Bldg 94 | Columbus | OH | 43224 | 5910 | Franklin | 40.08 | -82.93 | 1 | 5133285802 | 672 | 8/31/2022 7:28:06 AM | Details | ||||||
Rocco | Seth | Axon | Mr. | IV | 09/29/1995 | M | 900010719 | Seth | 1 | 3292 A C Wallace Lane | Suite 712 | Pen Argyl | PA | 18072 | 3420 | Northampton | 40.84 | -75.26 | 2 | 4846873108 | 5040 | 8/22/2022 2:23:42 PM | Details | ||||||
Spencer | Walter | Jentzen | Dr. | IV | 10/24/1986 | M | 900010900 | Walter | 2 | 4124 South Kimberly Dr | Benton | AR | 72015 | Saline | 34.61 | -92.67 | 2 | 5015767636 | 9/1/2022 4:41:59 AM | Details | |||||||||
Orval | Quinton | Behun | Mr. | IV | 03/20/1995 | M | 900010911 | Quinton | 2 | 3037 Reck Dr | Viola | AR | 72583 | 3734 | Fulton | 36.39 | -91.94 | 1 | 5013709786 | 7200 | 9/1/2022 5:33:02 AM | Details |
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