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General NPI Number Information
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NPI Number | 1194717595
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Entity Type | Individual
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Provider Name | EFSTRATIOS DEMETRIOS LAGOUTARIS DPM
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 1361 13TH AVE S STE 12
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250
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Country | US
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Telephone | 904-241-2655
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Fax | 904-249-2425
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Provider Business Mailing Address
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Address Line | 5911 TIMUQUANA RD UNIT 300
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City | JACKSONVILLE
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State | FL
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Zip | 32210-7897
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Country | US
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Telephone | 904-251-5053
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Fax | 904-224-2002
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO2989
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License Number State | FL
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