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General NPI Number Information
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NPI Number | 1255593984
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Entity Type | Individual
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Provider Name | PETER JAMES FIESTER M.D,
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Gender | Male
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 655 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 813-842-3771
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Fax |
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Provider Business Mailing Address
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Address Line | 2337 SW ARCHER RD APT 1031
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City | GAINESVILLE
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State | FL
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Zip | 32608-1005
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Country | US
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Telephone | 813-842-3771
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME118508
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License Number State | FL
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