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General NPI Number Information
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NPI Number | 1730985995
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Entity Type | Individual
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Provider Name | JUAN CAMILO CASTRO CARVAJAL MD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32610-3003
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Country | US
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Telephone | 352-594-4317
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Fax | 352-265-0279
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Provider Business Mailing Address
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Address Line | 8215 SW 64TH PL
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City | GAINESVILLE
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State | FL
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Zip | 32608-8544
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Country | US
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Telephone | 352-870-7026
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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 | 1933
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 1933
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License Number State | FL
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