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General NPI Number Information
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NPI Number | 1265585798
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Entity Type | Individual
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Provider Name | JOHN AUGUSTUS DRYFUSS JR.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7109 NW 11TH PL
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City | GAINESVILLE
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State | FL
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Zip | 32605-3170
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Country | US
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Telephone | 352-331-1773
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Fax | 352-331-1773
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Provider Business Mailing Address
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Address Line | 7109 NW 11TH PL
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City | GAINESVILLE
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State | FL
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Zip | 32605-3170
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Country | US
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Telephone | 352-331-1773
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Fax | 352-331-1773
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME0015017
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License Number State | FL
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