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General NPI Number Information
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NPI Number | 1801037254
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Entity Type | Individual
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Provider Name | BAYA OMIDNIA
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Gender | Female
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 402 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5247
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Country | US
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Telephone | 575-627-9500
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Fax | 575-627-4127
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Provider Business Mailing Address
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Address Line | PO BOX 1574
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City | ROSWELL
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State | NM
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Zip | 88202-1574
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Country | US
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Telephone | 575-627-9500
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Fax | 575-624-7537
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2009-0514
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License Number State | NM
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