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General NPI Number Information
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NPI Number | 1770789331
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Entity Type | Organization
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Legal Business Name | BRANCH MEDICAL CLINIC GUAM
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | BUILDING 6 CHAPEL ROAD
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City | SANTA RITA
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State | GU
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Zip | 96538
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Country | US
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Telephone | 671-339-7118
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 455 BOX 208
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City | FPO
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State | AP
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Zip | 96540-0003
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Country | US
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Telephone | 671-344-9242
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Fax |
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Authorized Official
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Title or Position | BUMED UBO
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Name | WILLIAM M CONDON
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Credential |
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Telephone | 240-401-3643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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