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General NPI Number Information
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NPI Number | 1124354592
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Entity Type | Organization
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Legal Business Name | TIM ROHAM D.O. INC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 629 CAMINO DE LOS MARES SUITE 103
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2834
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Country | US
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Telephone | 949-248-1900
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Fax | 949-248-1956
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Provider Business Mailing Address
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Address Line | 629 CAMINO DE LOS MARES SUITE 103
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2834
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Country | US
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Telephone | 949-248-1900
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Fax | 949-248-1956
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TIMOTHY OMID ROHAM
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Credential | D.O.
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Telephone | 949-248-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 29667
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License Number State | CA
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