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General NPI Number Information
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NPI Number | 1063445963
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Entity Type | Individual
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Provider Name | SEAN M MAHAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 2572 W STATE ROAD 426 SUITE 2032
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City | OVIEDO
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State | FL
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Zip | 32765-8389
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Country | US
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Telephone | 407-699-1100
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Fax | 407-218-8833
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Provider Business Mailing Address
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Address Line | 2572 W STATE ROAD 426 SUITE 2032
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City | OVIEDO
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State | FL
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Zip | 32765-8389
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Country | US
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Telephone | 407-699-1100
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Fax | 407-218-8833
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101228974
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME70745
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD21287
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License Number State | DC
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