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General NPI Number Information
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NPI Number | 1710324686
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Entity Type | Organization
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Legal Business Name | VALLEY ALLERGY & ASTHMA CLINIC LLC
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 10365 SE SUNNYSIDE RD SUITE 245
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City | CLACKAMAS
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State | OR
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Zip | 97015-5741
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Country | US
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Telephone | 503-208-9144
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Fax | 503-698-1900
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Provider Business Mailing Address
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Address Line | 10365 SE SUNNYSIDE RD SUITE 245
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City | CLACKAMAS
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State | OR
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Zip | 97015-5741
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | WASEEM MAKHOUL
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Credential | M.D.
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Telephone | 503-208-9144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD60113845
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD150278
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License Number State | OR
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