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General NPI Number Information
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NPI Number | 1073867941
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Entity Type | Individual
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Provider Name | EDWARD SALIB D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 2626 TAMPA RD STE 101
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City | PALM HARBOR
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State | FL
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Zip | 34684-3110
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Country | US
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Telephone | 727-754-1984
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Fax | 727-754-2868
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Provider Business Mailing Address
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Address Line | 1800 SE TIFFANY AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7521
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | UO 3009
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License Number State | FL
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