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General NPI Number Information
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NPI Number | 1316426257
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Entity Type | Individual
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Provider Name | ALAN MOUDY
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Gender | Male
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 1965 CAPITAL CIR NE STE 200
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City | TALLAHASSEE
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State | FL
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Zip | 32308-8402
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Country | US
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Telephone | 850-656-2006
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Fax |
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Provider Business Mailing Address
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Address Line | 2995 DREW ST
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City | CLEARWATER
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State | FL
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Zip | 33759-3012
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Country | US
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Telephone | 727-315-7496
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Fax |
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 11004124
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 11004124
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License Number State | FL
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