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General NPI Number Information
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NPI Number | 1992711659
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Entity Type | Organization
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Legal Business Name | CANYONVIEW FAMILY PRACTICE
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 3200 N CANYON RD STE C
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City | PROVO
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State | UT
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Zip | 84604-4571
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Country | US
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Telephone | 801-373-7373
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Fax | 801-373-1808
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Provider Business Mailing Address
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Address Line | 3200 N CANYON RD STE C
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City | PROVO
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State | UT
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Zip | 84604-4571
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Country | US
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Telephone | 801-373-7373
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Fax | 801-373-1808
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD L BAIRD
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Credential | DO
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Telephone | 801-373-7373
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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 | 39472
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License Number State | UT
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