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General NPI Number Information
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NPI Number | 1396064481
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Entity Type | Individual
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Provider Name | JOHN T GANTOMASSO DO
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Gender | Male
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 777 HEMLOCK ST
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City | MACON
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State | GA
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Zip | 31201-2102
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Country | US
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Telephone | 478-633-2147
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Fax | 478-742-9670
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Provider Business Mailing Address
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Address Line | PO BOX 551420
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City | FORT LAUDERDALE
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State | FL
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Zip | 33355-1420
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Country | US
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Telephone | 800-243-3839
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Fax | 855-851-4405
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 336060
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 076027
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 336060
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | OS017509
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License Number State | PA
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