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General NPI Number Information
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NPI Number | 1831253368
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Entity Type | Individual
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Provider Name | BENJAMIN O. DY M.D
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 4314 E PORTLAND AVE STE 7
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City | TACOMA
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State | WA
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Zip | 98404-4696
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Country | US
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Telephone | 253-476-9121
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Fax |
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Provider Business Mailing Address
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Address Line | 7116 153RD AVE NE
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City | REDMOND
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State | WA
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Zip | 98052-4297
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Country | US
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Telephone | 206-619-4965
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00025491
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License Number State | WA
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