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General NPI Number Information
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NPI Number | 1447371240
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Entity Type | Individual
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Provider Name | JOHN R POWELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 249 GLENWOOD RD
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City | BINGHAMTON
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State | NY
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Zip | 13905-1603
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Country | US
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Telephone | 607-770-0348
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CAMILLA ST
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City | CONKLIN
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State | NY
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Zip | 13748-1212
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NY187656
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License Number State | NY
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