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General NPI Number Information
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NPI Number | 1215033436
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Entity Type | Individual
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Provider Name | WILLIAM ANTHONY DENNIS-LEIGH PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 401 SW BEL AIRE DR
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City | CLATSKANIE
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State | OR
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Zip | 97016-1050
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Country | US
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Telephone | 503-728-5111
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Fax | 503-728-5115
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Provider Business Mailing Address
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Address Line | PO BOX 1050 401 BEL AIRE DR
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City | CLATSKANIE
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State | OR
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Zip | 97016-1050
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Country | US
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Telephone | 503-728-5111
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Fax | 503-728-5115
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA130052
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License Number State | OR
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