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General NPI Number Information
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NPI Number | 1336111533
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Entity Type | Individual
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Provider Name | JONATAN DE JESUS VALDEZ DIAZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 1670 ST VINCENTS WAY
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City | MIDDLEBURG
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State | FL
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Zip | 32068-8447
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Country | US
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Telephone | 904-308-3960
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Fax | 888-730-1925
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Provider Business Mailing Address
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Address Line | 1900 DON WICKHAM DR
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City | CLERMONT
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State | FL
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Zip | 34711-1979
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Country | US
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Telephone | 352-536-8840
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Fax | 352-536-8840
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 47902-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301085180
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME109787
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License Number State | FL
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