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General NPI Number Information
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NPI Number | 1528080678
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Entity Type | Individual
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Provider Name | TARI L ROCHE DO
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Gender | Female
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 2511 M AVE B
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City | ANACORTES
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State | WA
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Zip | 98221-3897
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Country | US
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Telephone | 360-299-4211
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Fax | 360-299-4213
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Provider Business Mailing Address
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Address Line | 1211 24TH ST
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City | ANACORTES
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State | WA
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Zip | 98221-2562
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Country | US
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Telephone | 360-299-4216
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Fax | 360-299-1369
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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 | OP00001743
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License Number State | WA
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