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General NPI Number Information
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NPI Number | 1760465850
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Entity Type | Individual
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Provider Name | RAYMOND B COORS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 9070 WINTON RD
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City | CINCINNATI
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State | OH
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Zip | 45231-3828
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Country | US
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Telephone | 513-246-7000
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Fax | 513-728-4344
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Provider Business Mailing Address
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Address Line | 4685 FOREST AVE STE C
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City | CINCINNATI
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State | OH
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Zip | 45212-3359
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Country | US
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Telephone | 513-246-7000
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 35040831
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35.040831
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 35.040831
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License Number State | OH
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