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General NPI Number Information
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NPI Number | 1588692651
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Entity Type | Individual
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Provider Name | WALTER F GOODWILLIE MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 1700 GEARY ST SE
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City | ALBANY
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State | OR
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Zip | 97322-6842
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Country | US
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Telephone | 541-812-5500
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Fax | 541-812-5584
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Provider Business Mailing Address
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Address Line | 1700 GEARY ST SE
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City | ALBANY
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State | OR
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Zip | 97322-6842
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Country | US
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Telephone | 541-812-5500
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Fax | 541-812-5584
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 7211
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD150133
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License Number State | OR
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