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General NPI Number Information
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NPI Number | 1699711564
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Entity Type | Organization
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Legal Business Name | T.W. MACLENNAN, M.D., A MEDICAL CORP
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 465 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3320
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Country | US
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Telephone | 559-310-0287
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | SIMI VALLEY
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State | CA
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Zip | 93062-0190
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Country | US
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Telephone | 559-310-0287
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Fax | 805-522-6401
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | THOMAS MACLENNAN
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Credential | M.D.
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Telephone | 559-310-0287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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