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General NPI Number Information
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NPI Number | 1346287471
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Entity Type | Individual
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Provider Name | JOHN CONRAD MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 202 N DIVISION ST SUITE 302
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City | AUBURN
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State | WA
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Zip | 98001-4939
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Country | US
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Telephone | 253-394-0125
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Fax | 253-394-0020
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Provider Business Mailing Address
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Address Line | PO BOX 2486
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City | OLYMPIA
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State | WA
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Zip | 98507-2486
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00046250
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License Number State | WA
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