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General NPI Number Information
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NPI Number | 1255583787
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Entity Type | Organization
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Legal Business Name | LAKE OKEECHOBEE DIGESTIVE DISEASE CENTER PA
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 204 SE PARK ST
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2967
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Country | US
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Telephone | 863-357-8222
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Fax |
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Provider Business Mailing Address
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Address Line | 9715 W BROWARD BLVD # 315
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City | PLANTATION
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State | FL
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Zip | 33324-2351
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Country | US
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Telephone | 863-357-8222
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | DAVID DUNCAN
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Credential |
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Telephone | 954-370-1053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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