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General NPI Number Information
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NPI Number | 1023492055
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Entity Type | Individual
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Provider Name | STEVEN JOEL DEVORE
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Gender | Male
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 1201 ORCHARD ST
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City | COVE
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State | OR
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Zip | 97824-8757
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Country | US
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Telephone | 541-910-8216
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Fax | 541-568-4030
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Provider Business Mailing Address
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Address Line | 1201 ORCHARD ST
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City | COVE
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State | OR
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Zip | 97824-8757
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Country | US
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Telephone | 541-910-8216
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Fax | 541-568-4030
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 525180
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License Number State | OR
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