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General NPI Number Information
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NPI Number | 1750718813
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Entity Type | Individual
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Provider Name | JASON LARSON RRT
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Gender | Male
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 250 HOSPITAL PL
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City | SOLDOTNA
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State | AK
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Zip | 99669-7559
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Country | US
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Telephone | 907-714-4686
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Fax | 907-714-4961
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Provider Business Mailing Address
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Address Line | 109 BLACKSTONE ST
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City | SOLDOTNA
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State | AK
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Zip | 99669-7869
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Country | US
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Telephone | 907-252-9877
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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 | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number |
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License Number State |
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