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General NPI Number Information
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NPI Number | 1285716977
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Entity Type | Organization
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Legal Business Name | OTSENRE E MATOS M D P A
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 4821 US HIGHWAY 19 STE 1
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City | NEW PRT RCHY
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State | FL
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Zip | 34652-4259
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Country | US
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Telephone | 727-849-2005
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Fax | 727-849-2087
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Provider Business Mailing Address
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Address Line | PO BOX 1014
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City | ELFERS
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State | FL
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Zip | 34680-1014
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Country | US
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Telephone | 727-849-2005
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Fax | 727-849-2087
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. OTSENRE E MATOS
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Credential | MD
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Telephone | 727-849-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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