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General NPI Number Information
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NPI Number | 1871617225
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Entity Type | Individual
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Provider Name | WILLIAM STEPHAN ROBERTS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4300 BARTLETT STREET SOUTH PENINSULA HOSPITAL
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City | HOMER
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State | AK
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Zip | 99603
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Country | US
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Telephone | 907-235-0362
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2434
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City | HOMER
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State | AK
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Zip | 99603-2434
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Country | US
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Telephone | 907-235-0362
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3293
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License Number State | AK
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