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General NPI Number Information
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NPI Number | 1760655575
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Entity Type | Individual
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Provider Name | CLOTILDE AMELIA JOHNSON-BEALE M.D., M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2008
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 25050 SE STARK ST STE 300
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City | GRESHAM
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State | OR
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Zip | 97030-3388
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Country | US
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Telephone | 503-667-8878
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Fax | 503-667-0310
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Provider Business Mailing Address
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Address Line | 25050 SE STARK ST STE 300
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City | GRESHAM
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State | OR
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Zip | 97030-3388
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Country | US
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Telephone | 503-667-8878
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Fax | 503-667-0310
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD158570
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License Number State | OR
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