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General NPI Number Information
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NPI Number | 1295406239
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Entity Type | Organization
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Legal Business Name | LEGACY MEDICAL CLINICS
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 830 N KROME AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030-4407
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Country | US
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Telephone | 305-726-2084
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Fax |
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Provider Business Mailing Address
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Address Line | 129 SEVILLA AVE
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City | CORAL GABLES
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State | FL
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Zip | 33134-6006
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Country | US
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Telephone | 786-761-5935
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Fax | 386-761-5936
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RONALD GONCALVES
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Credential |
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Telephone | 786-261-3143
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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