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General NPI Number Information
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NPI Number | 1205941093
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Entity Type | Organization
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Legal Business Name | RAINBOW MEDICAL GROUP
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 4700 N 51ST AVE STE 1
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City | PHOENIX
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State | AZ
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Zip | 85031-1237
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Country | US
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Telephone | 623-845-8200
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Fax | 623-845-8210
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Provider Business Mailing Address
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Address Line | PO BOX 6524
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City | GOODYEAR
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State | AZ
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Zip | 85338-0626
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Country | US
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Telephone | 623-845-8200
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Fax | 623-845-8210
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. BERNARD GOODMAN
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Credential | M.H.A.
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Telephone | 623-845-8200
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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 |
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License Number State | AZ
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