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General NPI Number Information
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NPI Number | 1942362199
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Entity Type | Individual
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Provider Name | THOMAS BOAZ STASON D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 226 SE 8TH AVE
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City | HILLSBORO
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State | OR
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Zip | 97123-4218
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Country | US
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Telephone | 503-601-7400
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Fax | 503-601-7311
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Provider Business Mailing Address
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Address Line | 1815 SW MARLOW AVE STE 110
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City | PORTLAND
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State | OR
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Zip | 97225-5186
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Country | US
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Telephone | 503-292-0765
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Fax | 503-292-5208
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | DO156749
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License Number State | OR
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