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General NPI Number Information
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NPI Number | 1710618566
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Entity Type | Individual
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Provider Name | JOSHUA VALDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 102 W KENWOOD AVE STE 100
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City | DECATUR
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State | IL
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Zip | 62526-4379
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Country | US
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Telephone | 217-872-3811
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Fax | 217-872-0849
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Provider Business Mailing Address
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Address Line | 3976 N WATER ST
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City | DECATUR
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State | IL
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Zip | 62526-1855
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Country | US
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Telephone | 630-696-1018
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.080959
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125.080959
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License Number State | IL
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