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General NPI Number Information
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NPI Number | 1598863177
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Entity Type | Individual
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Provider Name | PETER ANTHONY PRIMIANO II PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 2211 E. MILL PLAIN BV.,
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City | VANCOUVER
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State | WA
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Zip | 98661-4399
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Country | US
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Telephone | 360-449-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 7007 NE SACRAMENTO ST
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City | PORTLAND
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State | OR
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Zip | 97213-4756
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Country | US
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Telephone | 503-288-2909
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OR PA00152
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | WA PA10003987
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License Number State | WA
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