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General NPI Number Information
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NPI Number | 1326444795
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Entity Type | Organization
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Legal Business Name | FL PERFORMANCE,LLC
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 3125 INDEPENDENCE DR SUITE 300A1
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City | HOMEWOOD
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State | AL
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Zip | 35209-4159
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Country | US
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Telephone | 205-802-5949
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Fax |
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Provider Business Mailing Address
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Address Line | 3125 INDEPENDENCE DR SUITE 300A1
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City | HOMEWOOD
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State | AL
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Zip | 35209-4159
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Country | US
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Telephone | 205-802-5949
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. KIM FAGAN
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Credential | M.D.
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Telephone | 205-874-9940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 14105
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License Number State | AL
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