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General NPI Number Information
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NPI Number | 1184795163
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Entity Type | Individual
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Provider Name | MARIO FLORES GOLLE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 6900 GEORGIA AVE NW BLDG 1, RM A330, WRAMC
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City | WASHINGTON
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State | DC
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Zip | 20307-0003
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Country | US
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Telephone | 202-782-7364
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Fax | 202-782-4823
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Provider Business Mailing Address
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Address Line | WRAMC, 6900 GEORGIA AVE, NW BLDG 1, RM A330,
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City | WASHINGTON
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State | DC
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Zip | 20307
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Country | US
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Telephone | 202-782-7364
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Fax | 202-782-4823
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0033954
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License Number State | MD
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