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General NPI Number Information
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NPI Number | 1376712604
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Entity Type | Organization
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Legal Business Name | VISIONARY GYNECOLOGY PL
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 2695 ULMERTON RD
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City | CLEARWATER
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State | FL
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Zip | 33762-3335
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Country | US
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Telephone | 727-540-0414
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Fax | 727-540-0672
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Provider Business Mailing Address
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Address Line | 2840 W BAY DR #128
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City | BELLEAIR BLUFFS
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State | FL
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Zip | 33770-2620
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Country | US
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Telephone | 727-540-0414
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Fax | 727-540-0672
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Authorized Official
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Title or Position | SOLE MEMBER/OWNER
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Name | DR. JENNIFER S HAYES
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Credential | D.O.
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Telephone | 727-540-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | OS5756
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License Number State | FL
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