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General NPI Number Information
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NPI Number | 1992710461
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Entity Type | Individual
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Provider Name | STEVEN PERGAM MD
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Gender | Male
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 825 EASTLAKE AVE E
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City | SEATTLE
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State | WA
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Zip | 98109-4405
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Country | US
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Telephone | 206-667-6702
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50095
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City | SEATTLE
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State | WA
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Zip | 98145-5095
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Country | US
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Telephone | 206-543-6420
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | MD00045317
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License Number State | WA
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