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General NPI Number Information
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NPI Number | 1043956741
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Entity Type | Individual
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Provider Name | MARCOS ANTONIO RIVERA ROMAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 3647 S ORLANDO DR
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City | SANFORD
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State | FL
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Zip | 32773-5611
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Country | US
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Telephone | 407-541-0115
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Fax | 407-344-7910
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone | 844-630-0700
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Fax | 877-374-1924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ACN1503
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License Number State | FL
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