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General NPI Number Information
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NPI Number | 1114997491
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Entity Type | Individual
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Provider Name | OMAR MAURICIO SALAZAR MD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 6825 SW 87TH AVE
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City | MIAMI
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State | FL
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Zip | 33173-2502
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Country | US
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Telephone | 786-476-8854
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Fax | 786-476-8855
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Provider Business Mailing Address
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Address Line | 2160 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
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City | FORT MYERS
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State | FL
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Zip | 33907-1410
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 4301073591
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME105131
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License Number State | FL
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