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General NPI Number Information
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NPI Number | 1114240918
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Entity Type | Organization
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Legal Business Name | STEPHEN R SHAUL MD INC PS
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 4601 AVALANCHE AVE
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City | YAKIMA
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State | WA
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Zip | 98908-2830
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Country | US
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Telephone | 509-966-0292
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 AVALANCHE AVE
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City | YAKIMA
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State | WA
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Zip | 98908-2830
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Country | US
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Telephone | 509-966-0292
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN R SHAUL
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Credential | M.D.
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Telephone | 509-966-0292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD00011637
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License Number State | WA
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