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General NPI Number Information
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NPI Number | 1790930311
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Entity Type | Organization
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Legal Business Name | RADIATION ONCOLOGY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 504 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2439
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Country | US
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Telephone | 208-799-5600
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Fax | 208-799-5755
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Provider Business Mailing Address
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Address Line | PO BOX 1829
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City | COEUR D ALENE
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State | ID
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Zip | 83816-1829
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Country | US
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Telephone | 208-799-5600
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Fax | 208-799-5755
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Authorized Official
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Title or Position | OWNER
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Name | KENT W ANDERSON
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Credential | MD
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Telephone | 208-799-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State | ID
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