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General NPI Number Information
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NPI Number | 1417115197
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Entity Type | Individual
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Provider Name | RACHEL ROSE BENGTZEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD OHSU
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-3447
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Fax |
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Provider Business Mailing Address
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Address Line | 4411 SW VERMONT ST
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City | PORTLAND
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State | OR
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Zip | 97219-1020
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Country | US
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Telephone | 503-494-9992
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Fax | 503-494-1967
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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 | MD154177
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | MD154177
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License Number State | OR
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