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General NPI Number Information
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NPI Number | 1326193764
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Entity Type | Organization
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Legal Business Name | INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 9 SAN BARTOLA DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5767
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Country | US
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Telephone | 904-825-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 9143 PHILIPS HWY SUITE 560
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1348
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Country | US
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Telephone | 904-363-7453
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Fax | 904-538-3672
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT J PHELAN
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Credential |
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Telephone | 904-363-2113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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