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General NPI Number Information
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NPI Number | 1174094361
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Entity Type | Organization
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Legal Business Name | I.VIZION
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 5220 NW 163RD ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6226
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Country | US
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Telephone | 786-687-2420
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Fax |
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Provider Business Mailing Address
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Address Line | 5220 NW 163RD ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6226
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Country | US
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Telephone | 786-687-2420
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Fax |
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Authorized Official
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Title or Position | PROVIDER RELATIONS MANAGER
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Name | JEFFREY BRAZZLE
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Credential |
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Telephone | 954-918-7303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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