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General NPI Number Information
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NPI Number | 1518271097
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Entity Type | Individual
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Provider Name | GARY PATRICK MACDONALD D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 965 E 700 S STE 205
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City | ST GEORGE
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State | UT
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Zip | 84790-4085
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Country | US
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Telephone | 435-574-9146
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Fax | 435-574-9147
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Provider Business Mailing Address
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Address Line | 5148 N LONG SKY DR
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City | SAINT GEORGE
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State | UT
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Zip | 84770-7391
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Country | US
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Telephone | 435-602-3272
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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 | 85317151204
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License Number State | UT
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