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General NPI Number Information
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NPI Number | 1184854218
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Entity Type | Individual
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Provider Name | NATHANIEL JOHN U. CASTRO MD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 1200 SIXTH AVE N CENTRACARE CLINIC
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City | ST CLOUD
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State | MN
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Zip | 56303-2735
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Country | US
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Telephone | 612-625-3904
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 SIXTH AVE N CENTRACARE CLINIC
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City | ST CLOUD
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State | MN
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Zip | 56303-2735
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Country | US
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Telephone | 612-625-3904
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 105327
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License Number State | MN
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