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General NPI Number Information
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NPI Number | 1013413459
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Entity Type | Organization
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Legal Business Name | MOBILE MED, LLC
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3000 CENTRAL GARDENS CIR
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-8700
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Country | US
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Telephone | 561-406-9836
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1902
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City | JUPITER
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State | FL
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Zip | 33468-1902
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Country | US
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Telephone | 561-748-2889
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Fax | 561-748-1523
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICKY L STEWART
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Credential | PA-C
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Telephone | 516-373-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA3371
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License Number State | FL
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