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General NPI Number Information
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NPI Number | 1588684062
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Entity Type | Individual
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Provider Name | JAMES M VILLAREAL MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | CORNER OF ROUTE N12 AND N7
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504-0649
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Country | US
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Telephone | 928-729-8132
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30180
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City | SALT LAKE CITY
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State | UT
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Zip | 84130-0180
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Country | US
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Telephone | 801-269-2500
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Fax | 801-269-2696
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 275346-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 275346-1205
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License Number State | UT
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