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General NPI Number Information
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NPI Number | 1689652125
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Entity Type | Individual
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Provider Name | DARYL CHRISTOPHER HACKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 255 N BREIEL BLVD
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City | MIDDLETOWN
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State | OH
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Zip | 45042-3807
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Country | US
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Telephone | 513-422-5915
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Fax | 513-422-5101
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Provider Business Mailing Address
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Address Line | 255 N BREIEL BLVD
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City | MIDDLETOWN
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State | OH
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Zip | 45042-3807
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Country | US
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Telephone | 513-422-5915
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Fax | 513-422-5101
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35052293H
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License Number State | OH
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