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General NPI Number Information
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NPI Number | 1902848740
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Entity Type | Organization
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Legal Business Name | RADIATION MEDICAL GROUP
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5395 RUFFIN RD STE 103B
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City | SAN DIEGO
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State | CA
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Zip | 92123-1338
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Country | US
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Telephone | 619-505-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 CAMINO DEL RIO S STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92108-4107
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Country | US
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Telephone | 619-220-4100
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CFO
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Name | DOUGLAS MYKING
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Credential |
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Telephone | 619-220-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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