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General NPI Number Information
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NPI Number | 1720011406
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Entity Type | Organization
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Legal Business Name | WALLACE E RUMINSON MD INC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 444 W. PUTNAM
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City | PORTERVILLE
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State | CA
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Zip | 93257
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Country | US
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Telephone | 559-781-2079
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Fax | 559-781-4310
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Provider Business Mailing Address
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Address Line | 444 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3321
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Country | US
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Telephone | 559-781-2079
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Fax | 559-781-4310
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALLACE E RUMINSON
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Credential | MD
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Telephone | 559-781-2079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G28807
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License Number State | CA
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