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General NPI Number Information
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NPI Number | 1629164868
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Entity Type | Organization
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Legal Business Name | AMADOR FAMILY PHYSICIANS MEDICAL
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 605 NEW YORK RANCH RD
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City | JACKSON
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State | CA
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Zip | 95642-9328
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Country | US
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Telephone | 209-223-2030
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Fax | 209-223-2303
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Provider Business Mailing Address
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Address Line | PO BOX 1749
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City | JACKSON
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State | CA
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Zip | 95642-1749
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Country | US
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Telephone | 209-223-2030
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Fax | 209-223-2303
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEON LYNN TADLOCK
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Credential | M.D.
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Telephone | 209-223-2030
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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 |
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License Number State |
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