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General NPI Number Information
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NPI Number | 1235201526
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Entity Type | Organization
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Legal Business Name | BRIGHAM CITY ARTHRITIS CLINIC PC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 984 SOUTH MEDICAL DR SUITE #3
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City | BRIGHAM CITY
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State | UT
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Zip | 84302
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Country | US
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Telephone | 435-723-5500
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Fax | 435-723-5507
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Provider Business Mailing Address
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Address Line | PO BOX 95970
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-0970
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Country | US
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Telephone | 801-352-9500
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Fax | 801-352-9502
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Authorized Official
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Title or Position | PHYSICIAN
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Name | HAROLD VONK
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Credential | MD
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Telephone | 435-723-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 1695551205
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License Number State | UT
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