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General NPI Number Information
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NPI Number | 1073506614
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Entity Type | Individual
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Provider Name | GARY F PASTIZZO PA
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 9332 STATE ROAD 54 STE 405
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City | TRINITY
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State | FL
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Zip | 34655-1810
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Country | US
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Telephone | 727-375-8264
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Fax |
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Provider Business Mailing Address
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Address Line | 18951 ROSEATE DR
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City | LUTZ
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State | FL
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Zip | 33558-2316
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Country | US
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Telephone | 860-604-2998
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9110033
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9110033
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 000626
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License Number State | CT
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