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General NPI Number Information
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NPI Number | 1194738260
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Entity Type | Individual
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Provider Name | RAY BARTLETT P.A.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 723 1ST CAPITOL DR
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2729
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Country | US
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Telephone | 636-577-1357
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Fax | 636-447-1202
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Provider Business Mailing Address
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Address Line | 3009 N BALLAS RD STE 383C
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2324
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Country | US
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Telephone | 314-996-7014
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 104933
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License Number State | MO
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