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General NPI Number Information
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NPI Number | 1366409021
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Entity Type | Individual
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Provider Name | MITCHELL D TERK MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 710 LOMAX ST SUITE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4004
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Country | US
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Telephone | 904-483-2310
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Fax | 904-483-2313
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Provider Business Mailing Address
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Address Line | 7017 A C SKINNER PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6932
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Country | US
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Telephone | 904-520-6800
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Fax | 904-520-6801
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME73925
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License Number State | FL
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