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General NPI Number Information
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NPI Number | 1417213299
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Entity Type | Individual
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Provider Name | JEAN-YVES DASTAIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2012
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 1250 TAMIAMI TRL N STE 104
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City | NAPLES
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State | FL
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Zip | 34102-5267
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Country | US
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Telephone | 239-234-4482
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Fax | 833-563-2420
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Provider Business Mailing Address
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Address Line | 1250 TAMIAMI TRL NTH # 104
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City | NAPLES
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State | FL
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Zip | 34102
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Country | US
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Telephone | 239-234-4482
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Fax | 833-563-2420
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 139442
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 139442
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License Number State | FL
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