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General NPI Number Information
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NPI Number | 1033286034
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED MEDICAL GROUP, INC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 18619 SW 107TH AVE
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City | CUTLER BAY
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State | FL
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Zip | 33157-6728
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Country | US
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Telephone | 305-662-8559
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Fax | 305-667-6280
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Provider Business Mailing Address
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Address Line | 18619 SW 107TH AVE
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City | CUTLER BAY
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State | FL
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Zip | 33157-6728
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Country | US
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Telephone | 305-662-8559
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Fax | 305-667-6280
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GABRIEL A DELGADO
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Credential |
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Telephone | 305-662-8559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 847
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License Number State | FL
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