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General NPI Number Information
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NPI Number | 1285985630
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Entity Type | Organization
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Legal Business Name | COUPEVILLE CLINIC
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 202 N MAIN ST
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City | COUPEVILLE
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State | WA
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Zip | 98239-3420
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Country | US
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Telephone | 360-678-6576
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Fax | 360-678-3970
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Provider Business Mailing Address
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Address Line | PO BOX 1440
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City | COUPEVILLE
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State | WA
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Zip | 98239-1440
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Country | US
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Telephone | 360-678-6576
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Fax | 360-678-3970
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAN EUGENE FISHER
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Credential | MD
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Telephone | 360-678-6576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD60126180
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License Number State | WA
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