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General NPI Number Information
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NPI Number | 1992905814
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Entity Type | Individual
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Provider Name | JOSEPH STANLEY RESTIVO DO
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Gender | Male
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 3535 S I 35 E
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City | DENTON
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State | TX
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Zip | 76210-6850
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Country | US
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Telephone | 940-384-3810
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Fax | 940-565-9588
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Provider Business Mailing Address
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Address Line | PO BOX 745390
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City | ATLANTA
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State | GA
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Zip | 30374-5390
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Country | US
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Telephone | 940-384-3810
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Fax | 940-565-9588
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | U0266
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 05-35295
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License Number State | KS
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