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General NPI Number Information
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NPI Number | 1174526222
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Entity Type | Individual
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Provider Name | MICHAEL G MACON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 7700 E FLORENTINE RD BLDG B, STE 203
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2245
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Country | US
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Telephone | 928-442-8740
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Fax | 928-442-8142
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Provider Business Mailing Address
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Address Line | PO BOX 10880
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City | PRESCOTT
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State | AZ
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Zip | 86304-0880
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Country | US
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Telephone | 928-759-5874
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Fax | 928-458-2039
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D0030763
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 53388
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License Number State | AZ
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