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General NPI Number Information
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NPI Number | 1003013244
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Entity Type | Organization
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Legal Business Name | JAMES D. MICKLE JR. MD
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 137 MONTGOMERY AVE SUITE 203
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City | BOYERTOWN
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State | PA
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Zip | 19512-1300
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Country | US
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Telephone | 610-369-2050
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Fax | 610-369-2710
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Provider Business Mailing Address
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Address Line | 137 MONTGOMERY AVE SUITE 203
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City | BOYERTOWN
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State | PA
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Zip | 19512-1300
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Country | US
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Telephone | 610-369-2050
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Fax | 610-369-2710
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES D MICKLE JR.
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Credential | MD
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Telephone | 610-369-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MD016977E
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License Number State | PA
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