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General NPI Number Information
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NPI Number | 1023405065
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Entity Type | Organization
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Legal Business Name | MAYO CLINIC
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 4500 SAN PABLO RD S
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City | JACKSONVILLE
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State | FL
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Zip | 32224-1865
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Country | US
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Telephone | 904-953-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 SAN PABLO RD.
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City | JACKSONVILLE
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State | FL
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Zip | 32224
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Country | US
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Telephone | 904-953-7330
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Fax |
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Authorized Official
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Title or Position | DEPARTMENT CHAIR
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Name | DR. DAVID THIEL
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Credential |
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Telephone | 904-953-7330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | PA 3550
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License Number State | FL
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