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General NPI Number Information
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NPI Number | 1346272457
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Entity Type | Individual
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Provider Name | JASON DEAN SUNDSETH 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 | 07/08/2007
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Provider Practice Location Address
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Address Line | 10330 SE 32ND AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-6587
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Country | US
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Telephone | 503-513-8311
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Fax |
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Provider Business Mailing Address
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Address Line | 4708 W PRASCH AVE
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City | YAKIMA
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State | WA
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Zip | 98908-3753
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Country | US
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Telephone | 503-753-5898
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD23928
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License Number State | OR
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