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General NPI Number Information
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NPI Number | 1447723127
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Entity Type | Individual
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Provider Name | MARK W MALONE
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Gender | Male
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Dates
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Enumeration Date | 01/06/2019
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Last Update Date | 01/06/2019
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Provider Practice Location Address
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Address Line | 42234 MINNESOTA CREEK RD UNIT G
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City | PAONIA
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State | CO
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Zip | 81428-8125
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Country | US
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Telephone | 970-765-8551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1664
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City | PAONIA
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State | CO
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Zip | 81428-1664
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Country | US
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Telephone | 970-765-8551
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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 | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State | CO
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