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General NPI Number Information
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NPI Number | 1295913705
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Entity Type | Organization
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Legal Business Name | RAJENDRA H DWIVEDI M.D. INC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 623 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257
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Country | US
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Telephone | 559-781-2403
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Fax | 559-781-4334
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Provider Business Mailing Address
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Address Line | 623 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3212
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Country | US
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Telephone | 559-781-2403
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Fax | 559-781-4334
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Authorized Official
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Title or Position | UROLOGIST
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Name | DR. RAJENDRA H DWIVEDI
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Credential | M.D. M.S.
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Telephone | 559-781-2403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 00A337030
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License Number State | CA
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