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General NPI Number Information
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NPI Number | 1174720288
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Entity Type | Individual
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Provider Name | JACOB DANIEL HARRIS MD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 400 E 5TH AVE
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City | SPOKANE
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State | WA
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Zip | 99202-1334
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Country | US
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Telephone | 509-838-2531
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Fax | 509-755-6580
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Provider Business Mailing Address
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Address Line | 19020 33RD AVE W STE 210
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City | LYNNWOOD
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State | WA
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Zip | 98036-4748
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Country | US
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Telephone | 425-563-1500
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Fax | 425-563-1374
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M-13352
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD60655741
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License Number State | WA
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