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General NPI Number Information
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NPI Number | 1336341551
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Entity Type | Individual
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Provider Name | MATTHEW F DONNELLY PAC
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 2804 DEL PRADO BLVD S STE 109
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City | CAPE CORAL
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State | FL
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Zip | 33904-7283
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Country | US
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Telephone | 239-223-0039
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Fax | 866-582-5875
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Provider Business Mailing Address
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Address Line | PO BOX 152974
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City | CAPE CORAL
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State | FL
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Zip | 33915-2974
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Country | US
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Telephone | 239-223-0039
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Fax | 866-582-5875
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9104124
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License Number State | FL
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