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General NPI Number Information
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NPI Number | 1902904022
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Entity Type | Individual
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Provider Name | ENLOW RAYMOND WALKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 1919 LATHROP ST SUITE 100
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City | FAIRBANKS
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State | AK
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Zip | 99701-5930
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Country | US
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Telephone | 907-452-1761
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Fax | 907-452-6361
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Provider Business Mailing Address
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Address Line | PO BOX 55918
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City | NORTH POLE
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State | AK
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Zip | 99705-0918
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Country | US
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Telephone | 907-488-1442
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Fax | 907-452-6361
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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 | AA3094AK
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License Number State | AK
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