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General NPI Number Information
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NPI Number | 1942402847
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Entity Type | Individual
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Provider Name | TROY MICHAEL BAINBRIDGE P.A.-C, MPAS
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Gender | Male
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Dates
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Enumeration Date | 06/03/2007
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 912 PINE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2143
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Country | US
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Telephone | 503-813-2614
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Fax |
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Provider Business Mailing Address
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Address Line | 50 ALAMO AVE
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City | WEED
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State | CA
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Zip | 96094-2352
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Country | US
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Telephone | 503-853-1154
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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