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Case File
efta-02314900DOJ Data Set 11Other

EFTA02314900

Date
Unknown
Source
DOJ Data Set 11
Reference
efta-02314900
Pages
1
Persons
0
Integrity

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Extracted Text (OCR)

EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
WOODSON C. MERRELL, M.D. 44 EAST 67th STREET NEW YORK, NEW YORK 10065 Telephone Fax: Checklist for New Patient Inquiries Date: Name: Age: DOB: Address: Phone: SS#: Referred by: Current Primary Physician: Chief Complaints: EFTA_R1_01208164 EFTA02314900

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Phone2314900

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