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General NPI Number Information
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NPI Number | 1023568680
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Entity Type | Individual
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Provider Name | JAY DREW GOODMAN PT, SCS
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Gender | Male
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1603 HILLSBOROUGH ST 1603 HILLSBOROUGH STREET
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City | RALEIGH
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State | NC
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Zip | 27605-1638
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Country | US
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Telephone | 919-350-3800
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Fax | 919-838-5379
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Provider Business Mailing Address
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Address Line | 1603 HILLSBOROUGH ST WAKEMED AT ALEXANDER YMCA
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City | RALEIGH
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State | NC
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Zip | 27605-1638
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Country | US
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Telephone | 919-350-3800
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Fax | 919-838-5379
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | P5645
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License Number State | NC
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