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General NPI Number Information
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NPI Number | 1013954858
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Entity Type | Organization
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Legal Business Name | COCHISE ONCOLOGY LLC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 5151 E HIGHWAY 90
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2436
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Country | US
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Telephone | 520-803-6644
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Fax | 520-459-3193
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Provider Business Mailing Address
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Address Line | PO BOX 1418
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City | SIERRA VISTA
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State | AZ
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Zip | 85636-1418
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Country | US
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Telephone | 520-803-6644
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Fax | 520-459-3193
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Authorized Official
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Title or Position | DIRECTOR
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Name | JANET MARIE NETTLETON
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Credential | M.D.
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Telephone | 520-559-3684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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