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General NPI Number Information
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NPI Number | 1639880339
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Entity Type | Individual
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Provider Name | CARTER MAYOTTE RA
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Gender | Male
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 933 E PIERCE ST ATTN: RADIOLOGY DEPT
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4652
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Country | US
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Telephone | 712-396-6140
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Fax | 712-396-6227
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Provider Business Mailing Address
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Address Line | 14301 FNB PKWY STE 100
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City | OMAHA
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State | NE
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Zip | 68154-7200
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Country | US
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Telephone | 402-493-1212
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Fax | 866-363-5291
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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 | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | RAD103746
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License Number State | IA
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