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General NPI Number Information
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NPI Number | 1316074701
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Entity Type | Individual
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Provider Name | MOHAMMADREZA MINOUEI MD
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 303 N. CLYDE MORRIS BLVD SUITE 201
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2709
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Country | US
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Telephone | 386-226-4542
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Fax | 386-229-2354
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Provider Business Mailing Address
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Address Line | 303 N. CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2709
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Country | US
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Telephone | 386-425-2285
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Fax | 386-425-7522
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD430780
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME103732
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License Number State | FL
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