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General NPI Number Information
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NPI Number | 1477875094
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Entity Type | Individual
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Provider Name | MICHAEL R MCENTIRE MD
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Gender | Male
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-284-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-706-8526
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | M-12480
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | M-12480
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | R71475
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License Number State | AZ
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