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General NPI Number Information
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NPI Number | 1285667170
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Entity Type | Individual
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Provider Name | CHARLES EDWIN IRISH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 18650 NW CORNELL RD SUITE 212
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City | HILLSBORO
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State | OR
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Zip | 97124-9207
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Country | US
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Telephone | 503-292-1103
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Fax | 503-292-1433
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Provider Business Mailing Address
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Address Line | 9155 SW BARNES RD SUITE 830
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City | PORTLAND
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State | OR
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Zip | 97225-6625
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Country | US
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Telephone | 503-292-1103
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Fax | 503-292-1433
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD09659
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License Number State | OR
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