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General NPI Number Information
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NPI Number | 1639535990
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Entity Type | Individual
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Provider Name | JACOB DIGMANN ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 01/01/2016
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Last Update Date | 01/01/2016
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Provider Practice Location Address
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Address Line | 201 S MOUNTAIN AVE
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City | ASHLAND
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State | OR
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Zip | 97520-2165
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Country | US
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Telephone | 605-939-1740
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Fax |
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Provider Business Mailing Address
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Address Line | 255 DEL ISLE WAY
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City | EAGLE POINT
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State | OR
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Zip | 97524-9061
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Country | US
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Telephone | 605-939-1740
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-AT-10172069
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License Number State | OR
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