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General NPI Number Information
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NPI Number | 1386193597
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Entity Type | Organization
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Legal Business Name | MEDICAL STUDIO INC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 1437 FLAGLER AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8516
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Country | US
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Telephone | 904-575-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 4312 PLAZA GATE LN S APT 101
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City | JACKSONVILLE
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State | FL
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Zip | 32217-5411
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | DR. GABOR MENCZELESZ
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Credential | MD
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Telephone | 904-575-2285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME122201
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License Number State | FL
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