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General NPI Number Information
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NPI Number | 1023161221
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Entity Type | Organization
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Legal Business Name | MASTERS MEDICAL CENTER INC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1320 N SEMORAN BLVD SUITE 107
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City | ORLANDO
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State | FL
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Zip | 32807-3500
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Country | US
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Telephone | 407-207-3991
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 863982
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City | ORLANDO
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State | FL
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Zip | 32886-3982
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | BARBARA ST CLAIR
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Credential |
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Telephone | 407-207-3991
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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 |
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License Number State | FL
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