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General NPI Number Information
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NPI Number | 1073624649
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Entity Type | Individual
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Provider Name | LOVELL LEONARD MAYLE MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 17000 PORTER RD
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City | WINTER GARDEN
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State | FL
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Zip | 34787-8915
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Country | US
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Telephone | 321-842-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 15705 PANTHER LAKE DR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4567
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Country | US
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Telephone | 352-223-0061
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME59012
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License Number State | FL
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