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General NPI Number Information
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NPI Number | 1972553790
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Entity Type | Individual
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Provider Name | RANDOLPH L. ROYSTER JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 600 HOSPITAL DR SUITE 10
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City | CLYDE
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State | NC
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Zip | 28721-8046
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Country | US
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Telephone | 828-452-2320
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Fax | 828-456-4707
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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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 | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 19717
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License Number State | NC
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