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General NPI Number Information
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NPI Number | 1164246971
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Entity Type | Individual
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Provider Name | JACK SAMUEL CATANZARITE
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Gender | Male
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Dates
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Enumeration Date | 11/09/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 5050 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33813-2501
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Country | US
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Telephone | 863-688-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 CHELSEA CT
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City | PITTSBURGH
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State | PA
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Zip | 15237-6644
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Country | US
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Telephone | 412-600-9275
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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