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General NPI Number Information
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NPI Number | 1437155868
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Entity Type | Individual
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Provider Name | MICHAEL L MAGGARD O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 13930 7TH ST
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City | DADE CITY
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State | FL
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Zip | 33525-4904
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Country | US
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Telephone | 352-567-8989
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Fax | 352-567-0116
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Provider Business Mailing Address
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Address Line | 13930 7TH ST
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City | DADE CITY
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State | FL
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Zip | 33525-4904
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Country | US
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Telephone | 352-567-8989
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Fax | 352-567-0116
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OB 437
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 1762
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License Number State | FL
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