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General NPI Number Information
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NPI Number | 1003249764
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Entity Type | Organization
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Legal Business Name | JBM HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 4898 E IRLO BRONSON MEMORIAL HWY
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City | SAINT CLOUD
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State | FL
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Zip | 34771-8714
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Country | US
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Telephone | 863-512-4385
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Fax |
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Provider Business Mailing Address
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Address Line | 355 ALLISON AVE
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City | DAVENPORT
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State | FL
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Zip | 33897-5405
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Country | US
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Telephone | 863-512-4385
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN MORENO
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Credential | MD
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Telephone | 863-512-4385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN326
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License Number State | FL
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