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Medi-Cal Enrollment - Payer Description | Medical Staff Affairs
MD Form. DHCS 6216. NPI Copy of Drivers License (in State) Copy of MD License ; PAs Forms. DHCS 6207, DHCS 6208, DHCS 6248. NPI; Copy of Diploma; Copy of
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instructions for completion of the medi-cal rendering provider
DO NOT USE staples on this form as well as on any attachments. DO NOT USE correction tape, white out, or highlighter pen or ink of a similar type on this
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