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General NPI Number Information
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NPI Number | 1346239571
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Entity Type | Individual
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Provider Name | JEFFREY L AMODEO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 2200 JOHN R WOODEN DR
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1863
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Country | US
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Telephone | 765-342-5415
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Fax | 765-342-3415
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Provider Business Mailing Address
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Address Line | PO BOX 1557
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City | MARTINSVILLE
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State | IN
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Zip | 46151-0557
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Country | US
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Telephone | 765-349-4600
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Fax | 765-349-6590
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 234562
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01068850A
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License Number State | IN
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