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General NPI Number Information
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NPI Number | 1184076721
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Entity Type | Individual
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Provider Name | JASON RILEY C.P.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 1446 HOVER ST
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City | LONGMONT
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State | CO
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Zip | 80501-2485
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Country | US
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Telephone | 720-652-0100
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Fax | 720-652-0202
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Provider Business Mailing Address
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Address Line | 1446 HOVER ST
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City | LONGMONT
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State | CO
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Zip | 80501-2485
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Country | US
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Telephone | 720-652-0100
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Fax | 720-652-0202
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 20-4846654
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License Number State | CO
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