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General NPI Number Information
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NPI Number | 1265929319
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Entity Type | Individual
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Provider Name | JACOB WILLIAM ALBERT MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2018
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 34041 US 19 N STE E
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City | PALM HARBOR
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State | FL
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Zip | 34684-2648
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Country | US
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Telephone | 727-416-6832
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Fax | 727-416-6833
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 727-416-6832
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Fax | 727-416-6833
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME144266
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License Number State | FL
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