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General NPI Number Information
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NPI Number | 1801883319
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Entity Type | Individual
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Provider Name | JEFFREY BRYAN WALKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 2865 DAGGETT AVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1106
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Country | US
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Telephone | 541-882-6311
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 BEALL LN
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City | CENTRAL POINT
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State | OR
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Zip | 97502-1573
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Country | US
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Telephone | 541-664-5151
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Fax | 877-772-9433
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD153815
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License Number State | OR
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