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General NPI Number Information
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NPI Number | 1306583505
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Entity Type | Organization
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Legal Business Name | CAREDOC LLC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 4500 13TH ST
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City | GULFPORT
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State | MS
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Zip | 39501-2515
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Country | US
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Telephone | 228-265-1323
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Fax |
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Provider Business Mailing Address
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Address Line | 2194 HARMANSON VUE
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City | BILOXI
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State | MS
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Zip | 39531-5273
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Country | US
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Telephone | 228-236-3872
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATHAN BOLES
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Credential |
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Telephone | 228-265-1323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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