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General NPI Number Information
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NPI Number | 1790704393
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Entity Type | Individual
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Provider Name | ORVILLE H MANN III MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 915 HIGHLAND BLVD
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City | BOZEMAN
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State | MT
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Zip | 59715-6902
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Country | US
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Telephone | 800-461-3981
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Fax | 801-733-5872
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Provider Business Mailing Address
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Address Line | 88 SABER CIRCLE
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City | BOZEMAN
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State | MT
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Zip | 59715
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Country | US
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Telephone | 406-522-0544
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 9566
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License Number State | MT
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