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General NPI Number Information
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NPI Number | 1043270515
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Entity Type | Individual
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Provider Name | SUSAN M BATES MD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 6808 220TH ST SW STE 100
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2122
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Country | US
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Telephone | 425-744-7420
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Fax | 425-670-3378
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Provider Business Mailing Address
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Address Line | PO BOX 94580
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City | SEATTLE
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State | WA
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Zip | 98124-6880
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Country | US
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Telephone | 952-542-8553
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Fax | 952-513-6880
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD00036313
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License Number State | WA
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