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General NPI Number Information
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NPI Number | 1174181689
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Entity Type | Organization
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Legal Business Name | GABRIEL ZACHARIA REAGLE DO
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 1400 E CHURCH ST
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City | SANTA MARIA
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State | CA
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Zip | 93454-5906
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Country | US
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Telephone | 805-503-5312
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Fax | 805-973-2322
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Provider Business Mailing Address
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Address Line | 4554 WAVERTREE ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7831
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Country | US
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Telephone | 805-503-5312
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GABRIEL ZACHARIA REAGLE
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Credential | DO
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Telephone | 805-503-5312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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