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General NPI Number Information
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NPI Number | 1891747291
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Entity Type | Individual
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Provider Name | VERNON J COOLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 1820 SIDEWINDER DR
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City | PARK CITY
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State | UT
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Zip | 84060-7492
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Country | US
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Telephone | 435-655-6600
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Fax | 435-655-2388
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Provider Business Mailing Address
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Address Line | 900 ROUND VALLEY DR # 100
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City | PARK CITY
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State | UT
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Zip | 84060-7552
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Country | US
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Telephone | 435-655-6600
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Fax | 435-655-2388
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 321332-1205
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License Number State | UT
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