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General NPI Number Information
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NPI Number | 1841306339
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Entity Type | Individual
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Provider Name | GARY MARVIN THORNE MD, FACS
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 307 SAINT JOHNS WAY SUITE 5
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City | LEWISTON
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State | ID
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Zip | 83501-2435
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Country | US
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Telephone | 208-746-0133
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Fax | 208-746-0134
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Provider Business Mailing Address
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Address Line | 1624 SWALLOWS NEST LOOP
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City | CLARKSTON
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State | WA
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Zip | 99403-1726
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Country | US
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Telephone | 208-758-0361
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | M-3996
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License Number State | ID
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