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General NPI Number Information
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NPI Number | 1043771306
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Entity Type | Individual
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Provider Name | DAVID WALTON CRASTO JR. DO
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Gender | Male
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 154 S COMPASS WAY
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City | DANIA
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State | FL
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Zip | 33004-2368
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Country | US
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Telephone | 954-807-9433
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Fax | 954-807-9725
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Provider Business Mailing Address
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Address Line | 4030 DOGWOOD DR
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City | JACKSON
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State | MS
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Zip | 39211-6607
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Country | US
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Telephone | 601-613-7424
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS17041
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License Number State | FL
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Taxonomy #2
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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 |
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License Number State |
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