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General NPI Number Information
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NPI Number | 1003163320
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Entity Type | Organization
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Legal Business Name | DR. DONALD J FORNACE DO FACC INC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 1184 OCEAN SHORE BLVD
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City | ORMOND BEACH
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State | FL
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Zip | 32176-3760
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Country | US
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Telephone | 386-441-6636
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Fax | 386-441-6680
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Provider Business Mailing Address
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Address Line | 1184 OCEAN SHORE BLVD
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City | ORMOND BEACH
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State | FL
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Zip | 32176-3763
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Country | US
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Telephone | 386-441-6636
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Fax | 386-441-6680
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DONALD J FORNACE
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Credential | DO
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Telephone | 386-441-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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