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General NPI Number Information
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NPI Number | 1225085442
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Entity Type | Organization
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Legal Business Name | ANESTHESIA OF INDIAN RIVER INC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 09/17/2007
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Provider Practice Location Address
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Address Line | 1555 INDIAN RIVER BLVD SUITE B-120
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City | VERO BEACH
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State | FL
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Zip | 32960-7103
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Country | US
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Telephone | 352-867-8898
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Fax | 352-732-6282
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Provider Business Mailing Address
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Address Line | PO BOX 91853
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City | ORLANDO
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State | FL
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Zip | 32891-8953
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Country | US
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Telephone | 352-867-8898
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Fax | 352-732-6282
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Authorized Official
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Title or Position | AUTH REP
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Name | DONALD PORTELL
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Credential | D.O.
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Telephone | 352-867-8898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | FL
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