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General NPI Number Information
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NPI Number | 1588917009
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Entity Type | Individual
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Provider Name | CLAIRE-ALYCE ROCHELLE GOBBLE MD
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Gender | Female
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 1321 NE 99TH AVE SUITE 100
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City | PORTLAND
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State | OR
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Zip | 97220-9436
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Country | US
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Telephone | 503-215-9900
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Fax | 503-215-4025
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Provider Business Mailing Address
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Address Line | 1463 NE 20TH CT
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City | GRESHAM
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State | OR
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Zip | 97080-9662
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Country | US
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Telephone |
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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 | MD174040
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License Number State | OR
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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 | MD60491475
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License Number State | WA
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