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General NPI Number Information
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NPI Number | 1689573669
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Entity Type | Individual
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Provider Name | SAMANTHA LYNN ANNIS
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Gender | Female
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 207 FOOTE AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701-7077
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Country | US
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Telephone | 716-397-5768
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Fax |
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Provider Business Mailing Address
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Address Line | 15 ROGERS WAY
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City | FREWSBURG
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State | NY
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Zip | 14738-9589
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Country | US
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Telephone | 716-397-5768
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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 | 464547
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License Number State | NY
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