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General NPI Number Information
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NPI Number | 1780748590
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Entity Type | Individual
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Provider Name | PRUDENCE A SMITH M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 869 N CHERRY ST
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City | TULARE
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State | CA
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Zip | 93274-2207
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Country | US
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Telephone | 209-577-9900
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Fax | 209-577-1509
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Provider Business Mailing Address
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Address Line | 400 E OAK AVE
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City | VISALIA
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State | CA
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Zip | 93291-5034
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Country | US
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Telephone | 597-414-5705
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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 | A82397
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License Number State | CA
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