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General NPI Number Information
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NPI Number | 1023245867
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Entity Type | Individual
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Provider Name | CALVERT JOHN SHIPLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 9800 SE SUNNYSIDE RD
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City | CLACKAMAS
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State | OR
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Zip | 97015-9750
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Country | US
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Telephone | 503-653-6440
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Fax |
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Provider Business Mailing Address
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Address Line | 22824 SW LODGEPOLE AVE
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City | TUALATIN
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State | OR
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Zip | 97062-7611
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Country | US
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Telephone | 503-427-0089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OR MD11682
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License Number State | OR
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