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General NPI Number Information
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NPI Number | 1194093914
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Entity Type | Organization
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Legal Business Name | MARK COWARD MD PC
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 3700 S RUSSELL ST SUITE 115
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City | MISSOULA
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State | MT
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Zip | 59801-8574
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Country | US
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Telephone | 406-728-8530
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Fax | 406-728-1548
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Provider Business Mailing Address
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Address Line | 3700 S RUSSELL ST SUITE 115
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City | MISSOULA
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State | MT
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Zip | 59801-8579
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Country | US
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Telephone | 406-728-8530
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Fax | 406-728-1548
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Authorized Official
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Title or Position | OWNER
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Name | MARK H COWARD
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Credential | M.D.
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Telephone | 406-728-8530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 5149
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License Number State | MT
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