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General NPI Number Information
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NPI Number | 1467415471
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Entity Type | Individual
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Provider Name | THOMAS E. MOOSE RPA-C
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Gender | Male
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 CANAL VIEW BLVD SUITE 102
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City | ROCHESTER
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State | NY
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Zip | 14623-2852
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Country | US
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Telephone | 585-461-5330
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Fax | 585-461-9895
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Provider Business Mailing Address
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Address Line | 12 CHELSEA WAY
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City | FAIRPORT
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State | NY
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Zip | 14450-3215
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Country | US
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Telephone | 585-425-3245
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 006431
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License Number State | NY
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