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General NPI Number Information
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NPI Number | 1235427675
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Entity Type | Individual
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Provider Name | PRIYANKA RAVAL
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Gender | Female
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 6420 CLAYTON RD DEPARTMENT OF INTERNAL MEDICINE (SUITE #2214 )
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1811
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Country | US
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Telephone | 501-766-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 15TH STREET BAA 5407
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City | AUGUSTA
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State | GA
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Zip | 30912-3001
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Country | US
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Telephone | 706-721-2505
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2011012664
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License Number State | MO
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