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General NPI Number Information
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NPI Number | 1356329783
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Entity Type | Individual
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Provider Name | DAVID REED CONDIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-785-4100
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Fax | 210-292-3760
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Provider Business Mailing Address
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Address Line | 9592 N DEERFIELD LN
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City | CEDAR HILLS
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State | UT
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Zip | 84062-7707
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Country | US
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Telephone | 210-216-4742
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 35-067004
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036.127977
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | M-12609
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License Number State | ID
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