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General NPI Number Information
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NPI Number | 1093142747
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Entity Type | Individual
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Provider Name | GRACE MAHER REYNOLDS M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 1849 SOUTH OCEAN DR. PTS 911
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009
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Country | US
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Telephone | 954-457-2744
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Fax | 954-457-2744
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Provider Business Mailing Address
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Address Line | 1849 SOUTH OCEAN DR. P.T.S. 911
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009
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Country | US
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Telephone | 954-457-2744
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Fax | 954-457-2744
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3271871
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License Number State | FL
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