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General NPI Number Information
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NPI Number | 1144402199
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Entity Type | Organization
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Legal Business Name | VANCE J MALONEY III MD PA
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Dates
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Enumeration Date | 12/01/2007
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Last Update Date | 11/16/2013
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Provider Practice Location Address
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Address Line | 1315 HICKORY DR
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City | LONGWOOD
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State | FL
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Zip | 32779-5844
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Country | US
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Telephone | 407-701-0012
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 HICKORY DR
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City | LONGWOOD
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State | FL
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Zip | 32779-5844
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Country | US
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Telephone | 407-701-0012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VANCE J MALONEY III
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Credential | MD
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Telephone | 407-701-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 24866
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License Number State | FL
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