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General NPI Number Information
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NPI Number | 1861734915
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Entity Type | Individual
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Provider Name | JORDAN TAYLOR VULCANO DO
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Gender | Male
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 1801 S. CRISMON ROAD SUITE 191
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City | MESA
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State | AZ
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Zip | 85209
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Country | US
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Telephone | 480-621-5891
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Fax | 480-704-4019
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Provider Business Mailing Address
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Address Line | 1801 S. CRISMON ROAD SUITE 191
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City | MESA
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State | AZ
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Zip | 85209
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Country | US
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Telephone | 480-621-5891
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Fax | 480-704-4019
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | D01358731
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 007950
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License Number State | AZ
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