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General NPI Number Information
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NPI Number | 1750875449
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Entity Type | Individual
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Provider Name | CAMERON DUANE MACINNIS MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 717 CENTER ST
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City | HEALDSBURG
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State | CA
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Zip | 95448-3604
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Country | US
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Telephone | 707-473-0833
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Fax | 707-473-0843
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone | 707-473-0833
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Fax | 707-473-0843
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A173787
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License Number State | CA
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