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General NPI Number Information
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NPI Number | 1144767997
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Entity Type | Organization
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Legal Business Name | BAPTIST ENT SPECIALISTS INC
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 7740 POINT MEADOWS DR SUITE 7
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9179
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Country | US
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Telephone | 904-202-6400
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Fax | 904-541-4728
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Provider Business Mailing Address
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Address Line | PO BOX 41516
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City | JACKSONVILLE
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State | FL
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Zip | 32203-1516
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Country | US
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Telephone | 904-202-5111
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Fax | 904-391-5836
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CATHERINE GRAHAM
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Credential |
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Telephone | 904-202-5370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | FL
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