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General NPI Number Information
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NPI Number | 1184810053
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Entity Type | Organization
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Legal Business Name | RAVISHANKAR L RAO M D PA
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 15435 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6113
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Country | US
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Telephone | 352-796-2909
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Fax | 352-796-8196
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Provider Business Mailing Address
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Address Line | 15435 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6113
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Country | US
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Telephone | 352-796-2909
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Fax | 352-796-8196
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | RAVISHANKAR L RAO
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Credential | MD
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Telephone | 352-796-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 0063596
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License Number State | FL
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