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General NPI Number Information
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NPI Number | 1154503654
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Entity Type | Organization
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Legal Business Name | MID-FLORIDA PULMONARY ASSOCIATES PA
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 720 N BAY ST STE 4
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City | EUSTIS
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State | FL
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Zip | 32726
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Country | US
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Telephone | 352-483-1960
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Fax | 352-483-0660
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Provider Business Mailing Address
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Address Line | 720 N BAY ST STE 4
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City | EUSTIS
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State | FL
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Zip | 32726-2964
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Country | US
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Telephone | 352-483-1960
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Fax | 352-483-0660
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SABARETNAM YOGENDRA
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Credential | M.D.
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Telephone | 352-483-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME55648
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License Number State | FL
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