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General NPI Number Information
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NPI Number | 1639180698
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Entity Type | Individual
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Provider Name | COREY B JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1219 N 400 E
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City | LOGAN
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State | UT
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Zip | 84341-2321
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Country | US
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Telephone | 435-753-2842
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Fax |
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Provider Business Mailing Address
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Address Line | 139 S 200 W
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City | HYRUM
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State | UT
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Zip | 84319-1241
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Country | US
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Telephone | 435-245-3348
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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 | 1848241205
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License Number State | UT
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