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General NPI Number Information
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NPI Number | 1427923192
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Entity Type | Organization
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Legal Business Name | OREGON COAST WOUND CENTER LLC
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 1610 THOMPSON RD
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City | COOS BAY
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State | OR
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Zip | 97420-2150
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Country | US
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Telephone | 541-329-2555
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Fax | 971-233-3243
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Provider Business Mailing Address
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Address Line | 780 2ND ST SE STE 7
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City | BANDON
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State | OR
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Zip | 97411-8354
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Country | US
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Telephone | 541-329-2555
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Fax | 971-233-3243
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Authorized Official
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Title or Position | OWNER
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Name | BABAK BAHARLOO
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Credential | DMP
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Telephone | 541-329-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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