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General NPI Number Information
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NPI Number | 1114143930
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Entity Type | Individual
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Provider Name | RAUL ANTHONY MENDIOLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 1230 BAXTER ST
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City | ATHENS
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State | GA
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Zip | 30606-3712
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Country | US
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Telephone | 706-227-3450
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Fax |
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Provider Business Mailing Address
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Address Line | 226 E VINELAND RD
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City | AUGUSTA
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State | GA
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Zip | 30904-3414
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Country | US
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Telephone | 706-372-8085
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 062258
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License Number State | GA
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