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General NPI Number Information
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NPI Number | 1023210986
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Entity Type | Organization
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Legal Business Name | NORTH FL ARTHRITIS CLINIC, PA.
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 4551 W EST US 90 SUITE 102
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City | LAKE CITY
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State | FL
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Zip | 32055
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Country | US
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Telephone | 386-719-6520
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Fax | 386-719-6592
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Provider Business Mailing Address
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Address Line | 4551 W EST US 90 SUITE 102
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City | LAKE CITY
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State | FL
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Zip | 32055
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Country | US
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Telephone | 386-719-6520
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Fax | 386-719-6592
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SUSANNE CICERO
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Credential |
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Telephone | 386-719-6520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME70903
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License Number State | FL
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