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General NPI Number Information
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NPI Number | 1215198163
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Entity Type | Individual
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Provider Name | RAVI MYDUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 4343 N JOSEY LN
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City | CARROLLTON
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State | TX
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Zip | 75010-4603
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Country | US
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Telephone | 972-492-1010
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Fax | 479-242-1990
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Provider Business Mailing Address
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Address Line | 5707 JENNY LIND RD
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City | FORT SMITH
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State | AR
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Zip | 72908-7435
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Country | US
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Telephone | 479-452-9416
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Fax | 479-242-1990
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | BP2-0032086
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License Number State | TX
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