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General NPI Number Information
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NPI Number | 1053943787
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Entity Type | Organization
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Legal Business Name | BOND CLINIC PA
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 2039 E EDGEWOOD DR
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City | LAKELAND
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State | FL
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Zip | 33803-3601
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Country | US
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Telephone | 863-293-1191
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E CENTRAL AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3094
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Country | US
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Telephone | 863-293-1191
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JASON A MOERSCHBACHER
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Credential |
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Telephone | 863-293-1191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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