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General NPI Number Information
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NPI Number | 1891901674
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Entity Type | Individual
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Provider Name | MARY KATHERINE YODER M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 4205 BELFORT RD SUITE 3075
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1475
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Country | US
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Telephone | 904-308-7790
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Fax | 904-296-4786
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Provider Business Mailing Address
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Address Line | 4205 BELFORT RD SUITE 3075
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1475
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Country | US
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Telephone | 904-308-7790
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Fax | 904-296-4786
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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 | 0101242688
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 106212
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License Number State | FL
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