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General NPI Number Information
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NPI Number | 1083672919
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Entity Type | Individual
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Provider Name | JONATHAN E ALLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 424 WILLIAMS ST
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City | ANGOLA
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State | IN
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Zip | 46703-1556
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Country | US
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Telephone | 260-665-5170
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Fax | 260-665-6979
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Provider Business Mailing Address
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Address Line | 424 WILLIAMS ST
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City | ANGOLA
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State | IN
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Zip | 46703-1556
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Country | US
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Telephone | 260-665-5170
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Fax | 260-665-6979
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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 | 50003955A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 20014061
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License Number State | IN
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