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General NPI Number Information
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NPI Number | 1417957820
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Entity Type | Individual
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Provider Name | MEKO M RADOMSKI MD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2006 MOORES LN
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City | TEXARKANA
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State | TX
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Zip | 75503-1840
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Country | US
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Telephone | 903-614-5033
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 SAINT MICHAEL DR STE 401
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City | TEXARKANA
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State | TX
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Zip | 75503-5211
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Country | US
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Telephone | 903-614-5367
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | J2265
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License Number State | TX
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