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General NPI Number Information
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NPI Number | 1811067283
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Entity Type | Individual
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Provider Name | MICHAEL ROY MCFADDEN SR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3584 WEST 9000 SOUTH SUITE 401
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City | WEST JORDAN
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State | UT
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Zip | 84088
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Country | US
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Telephone | 801-566-0204
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 680290
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City | PARK CITY
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State | UT
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Zip | 84068-0290
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Country | US
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Telephone | 801-450-5454
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 159085-1205
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License Number State | UT
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