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General NPI Number Information
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NPI Number | 1326101270
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Entity Type | Organization
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Legal Business Name | ANDALUSIA PAIN, REHAB & SPORTS MEDICINE
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 10/28/2007
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Provider Practice Location Address
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Address Line | 12671 US HIGHWAY 98 W FOUNTAIN PLAZA SUITE 215
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City | SANDESTIN
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State | FL
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Zip | 32550-8300
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Country | US
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Telephone | 850-654-4041
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Fax | 850-654-5339
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Provider Business Mailing Address
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Address Line | PO BOX 6855
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-1015
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Country | US
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Telephone | 850-654-4041
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Fax | 850-654-5339
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Authorized Official
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Title or Position | MD PRESIDENT
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Name | DR. JAIME ARTURO FOLAND
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Credential | MD
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Telephone | 850-654-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25663
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME89138
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25663
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME89138
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License Number State | FL
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