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General NPI Number Information
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NPI Number | 1386617223
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Entity Type | Individual
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Provider Name | SIMON PAUL CARLSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 2200 PARK BEND DR BLDG 2
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City | AUSTIN
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State | TX
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Zip | 78758-5387
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Country | US
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Telephone | 512-351-8386
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 PARK BEND DR BLDG 2
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City | AUSTIN
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State | TX
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Zip | 78758-5387
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Country | US
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Telephone | 512-351-8386
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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 | D0063079
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M9196
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License Number State | TX
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