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General NPI Number Information
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NPI Number | 1891716478
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Entity Type | Individual
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Provider Name | TIMOTHY M MOONEY DPM
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 2385 E PRATER WAY SUITE 205
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City | SPARKS
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State | NV
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Zip | 89434-9629
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Country | US
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Telephone | 775-356-4888
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Fax | 775-356-4890
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Provider Business Mailing Address
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Address Line | PO BOX 3046
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City | MALVERN
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State | PA
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Zip | 19355-0746
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Country | US
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Telephone | 775-356-4888
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0008
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License Number State | NV
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