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General NPI Number Information
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NPI Number | 1336161546
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Entity Type | Individual
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Provider Name | PAUL W SHANK MD, FACS
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 223 SOUTH PLEASANT AVENUE SUITE 405
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City | SOMERSET
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State | PA
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Zip | 15501
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Country | US
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Telephone | 814-443-4634
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Fax | 814-445-3819
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Provider Business Mailing Address
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Address Line | 223 SOUTH PLEASANT AVENUE SUITE 405
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City | SOMERSET
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State | PA
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Zip | 15501
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Country | US
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Telephone | 814-443-4634
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Fax | 814-445-3819
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD043731L
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License Number State | PA
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