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General NPI Number Information
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NPI Number | 1013117472
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Entity Type | Organization
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Legal Business Name | RONALD E GROW INC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 810 W INDIANA AVE
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City | SOUTH BEND
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State | IN
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Zip | 46613-1828
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Country | US
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Telephone | 574-289-5049
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Fax | 574-288-0840
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Provider Business Mailing Address
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Address Line | 810 W INDIANA AVE
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City | SOUTH BEND
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State | IN
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Zip | 46613-1828
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Country | US
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Telephone | 574-289-5049
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Fax | 574-288-0840
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD E GROW
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Credential | DO
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Telephone | 574-289-5049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02000101A
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License Number State | IN
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