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General NPI Number Information
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NPI Number | 1164608295
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Entity Type | Organization
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Legal Business Name | JOHN L COON MD INC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 3975 JACKSON ST SUITE 201
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City | RIVERSIDE
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State | CA
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Zip | 92503-3901
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Country | US
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Telephone | 951-687-9400
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Fax | 951-687-9401
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Provider Business Mailing Address
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Address Line | PO BOX 7578
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City | RIVERSIDE
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State | CA
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Zip | 92513-7578
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Country | US
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Telephone | 951-751-9400
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Fax | 951-352-5329
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN L COON
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Credential | M.D.
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Telephone | 951-751-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G31115
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License Number State | CA
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