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General NPI Number Information
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NPI Number | 1174613608
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Entity Type | Individual
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Provider Name | ROBERT AUSTIN GORSUCH D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1601 E FOURTH PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-3753
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Country | US
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Telephone | 503-220-8262
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Fax | 360-905-1733
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Provider Business Mailing Address
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Address Line | PO BOX 1034 MAIL CODE V3GP3
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City | PORTLAND
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State | OR
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Zip | 97207-1034
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Country | US
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Telephone | 503-220-8262
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Fax | 360-905-1733
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DO14735
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License Number State | OR
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