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General NPI Number Information
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NPI Number | 1326156399
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Entity Type | Organization
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Legal Business Name | CITRUS CHEST AND LUNG SPEC PA
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 318 SOUTH LINE AVE
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City | INVERNESS
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State | FL
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Zip | 34452-4606
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Country | US
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Telephone | 352-637-5678
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Fax | 352-344-3569
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Provider Business Mailing Address
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Address Line | 318 SOUTH LINE AVE
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City | INVERNESS
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State | FL
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Zip | 34452-4606
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Country | US
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Telephone | 352-637-5678
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Fax | 352-344-3569
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. GWENDOLYN L PIAZZA
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Credential |
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Telephone | 352-637-5678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME0052185
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License Number State | FL
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