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General NPI Number Information
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NPI Number | 1033375092
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Entity Type | Individual
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Provider Name | BALA ARUL VINAYAK KRISHNAN M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 707 SW WASHINGTON ST SUITE 700
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City | PORTLAND
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State | OR
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Zip | 97205-3536
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Country | US
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Telephone | 503-299-9906
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Fax | 503-225-9002
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Provider Business Mailing Address
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Address Line | PO BOX 2040 CAMPUS BOX 356540
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City | PORTLAND
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State | OR
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Zip | 97208-2040
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Country | US
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Telephone | 503-299-9906
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Fax | 503-225-9002
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD159815
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License Number State | OR
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