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General NPI Number Information
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NPI Number | 1821268822
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Entity Type | Organization
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Legal Business Name | WILLAMETTE CLINIC, LLC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 1750 BLANKENSHIP ROAD SUITE 280
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City | WEST LINN
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State | OR
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Zip | 97068-8269
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Country | US
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Telephone | 503-496-0290
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Fax | 503-496-3166
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Provider Business Mailing Address
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Address Line | 1750 BLANKENSHIP ROAD SUITE 280
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City | WEST LINN
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State | OR
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Zip | 97068-8269
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Country | US
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Telephone | 503-496-0290
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Fax | 503-496-3166
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHERI L LAIRD
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Credential | MD
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Telephone | 503-496-0290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD21936
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License Number State | OR
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