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General NPI Number Information
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NPI Number | 1174704605
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Entity Type | Organization
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Legal Business Name | PULMONARY AND CRITICAL CARE ASSOCIATES P A
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 4201 BELFORT RD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1431
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Country | US
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Telephone | 904-366-3738
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Fax | 904-354-3571
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Provider Business Mailing Address
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Address Line | 1893 KINGSLEY AVE SUITE C
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City | ORANGE PARK
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State | FL
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Zip | 32073-4491
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Country | US
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Telephone | 904-276-2044
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Fax | 904-276-2106
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Authorized Official
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Title or Position | DIRECTOR
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Name | STUART Z MILLSTONE
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Credential | MD
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Telephone | 904-276-2044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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