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General NPI Number Information
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NPI Number | 1205112240
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Entity Type | Organization
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Legal Business Name | MARK T. KOWAL MD PC
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 1919 LATHROP ST SUITE 202
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City | FAIRBANKS
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State | AK
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Zip | 99701-5937
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Country | US
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Telephone | 907-451-5507
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Fax | 907-451-5590
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Provider Business Mailing Address
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Address Line | 1919 LATHROP ST SUITE 202
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City | FAIRBANKS
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State | AK
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Zip | 99701-5937
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Country | US
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Telephone | 907-451-5507
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Fax | 907-451-5590
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | DR. MARK TIMOTHY KOWAL
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Credential | MD
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Telephone | 907-451-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7319
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License Number State | AK
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