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General NPI Number Information
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NPI Number | 1912636317
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Entity Type | Individual
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Provider Name | CONNOR DEACON MOONEY MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 02/08/2026
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Provider Practice Location Address
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Address Line | 128 E. APPLE ST. WCHE 7TH FLOOR
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City | DAYTON
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State | OH
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Zip | 45409
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Country | US
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Telephone | 937-208-2951
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Fax |
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Provider Business Mailing Address
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Address Line | 128 E. APPLE ST. WCHE 7TH FLOOR
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City | DAYTON
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State | OH
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Zip | 45409
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 35.151631
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License Number State | OH
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