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General NPI Number Information
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NPI Number | 1386942860
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Entity Type | Organization
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Legal Business Name | JEFFREY B. COMITALO, MD, PA
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 8333 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32514-6050
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Country | US
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Telephone | 850-474-8342
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Fax | 850-969-2886
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Provider Business Mailing Address
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Address Line | PO BOX 10271
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City | PENSACOLA
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State | FL
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Zip | 32524-0271
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Country | US
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Telephone | 850-474-8342
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Fax | 850-969-2886
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY BRIAN COMITALO
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Credential | M.D.
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Telephone | 850-474-8342
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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 | ME74536
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License Number State | FL
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