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General NPI Number Information
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NPI Number | 1407891013
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Entity Type | Individual
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Provider Name | JAMES KEVIN POITRAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 2100 VIA BELLA BLVD SUITE 101
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City | LAND O LAKES
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State | FL
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Zip | 34639-5429
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Country | US
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Telephone | 813-948-1498
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Fax | 813-355-5040
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Provider Business Mailing Address
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Address Line | 38135 MARKET SQ
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-7505
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Country | US
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Telephone | 813-528-4975
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME88071
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | ME88071
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License Number State | FL
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