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General NPI Number Information
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NPI Number | 1972516565
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Entity Type | Individual
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Provider Name | PRABHAKAR VENKATA RATNA BHAMIDIPATI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-0185
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Fax |
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Provider Business Mailing Address
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Address Line | 4448 RED BARN
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City | RICHARDSON
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State | TX
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Zip | 75082-2680
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Country | US
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Telephone | 972-690-1626
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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 | 44714-020
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License Number State | WI
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