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General NPI Number Information
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NPI Number | 1467628362
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Entity Type | Individual
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Provider Name | JOSH LARSON
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Gender | Male
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 2800 CLEVELAND AVE N
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City | ROSEVILLE
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State | MN
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Zip | 55113-1126
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Country | US
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Telephone | 651-642-1825
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Fax |
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Provider Business Mailing Address
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Address Line | 4217 24TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55406-3027
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Country | US
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Telephone | 651-642-1825
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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 | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | 207
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License Number State | MN
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