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General NPI Number Information
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NPI Number | 1861429235
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Entity Type | Individual
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Provider Name | AN CONG VU MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 10/12/2010
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Provider Practice Location Address
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Address Line | 450 VILLA RD
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City | NEWBERG
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State | OR
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Zip | 97132-1857
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Country | US
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Telephone | 503-538-7331
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Fax | 503-538-7333
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Provider Business Mailing Address
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Address Line | 11110 NW MONTREUX LANE
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City | PORTLAND
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State | OR
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Zip | 97229
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Country | US
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Telephone | 503-646-8533
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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 | MD14665
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License Number State | OR
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