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General NPI Number Information
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NPI Number | 1750018164
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Entity Type | Individual
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Provider Name | CONNOR JAMES RICHARDSON PA
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Gender | Male
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 384 SE COMBS FLAT RD STE 1200
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City | PRINEVILLE
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State | OR
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Zip | 97754-2562
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Country | US
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Telephone | 541-447-6263
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6095
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City | BEND
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State | OR
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Zip | 97708-6095
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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 |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA221451
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License Number State | OR
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