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General NPI Number Information
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NPI Number | 1902167950
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Entity Type | Individual
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Provider Name | HARVEY JAY TUCKER MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 466 MISSOURI
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City | SAN FRANCISCO
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State | CA
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Zip | 94107
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Country | US
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Telephone | 415-517-8772
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Fax | 503-636-0940
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Provider Business Mailing Address
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Address Line | 16869 65TH AVE #315
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-7865
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Country | US
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Telephone | 503-636-3898
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Fax | 503-636-0940
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G-16516
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License Number State | CA
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