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General NPI Number Information
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NPI Number | 1063476356
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Entity Type | Individual
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Provider Name | TAN LUCIEN HASSAN MOHAMMED MD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD # 100374
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City | GAINESVILLE
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State | FL
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Zip | 32610-0374
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Country | US
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Telephone | 352-265-0291
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Fax | 352-265-0279
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Provider Business Mailing Address
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Address Line | 1100 9TH AVE
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City | SEATTLE
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State | WA
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Zip | 98101-2756
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Country | US
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Telephone | 206-515-5811
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Fax | 206-515-5886
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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 | MD2022-0580
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License Number State | NM
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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 | 35084772
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License Number State | OH
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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 | ME120580
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License Number State | FL
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