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General NPI Number Information
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NPI Number | 1437297892
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Entity Type | Organization
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Legal Business Name | WATSON CLINIC LLP
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 615 E ALEXANDER ST
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City | PLANT CITY
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State | FL
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Zip | 33563-7126
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Country | US
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Telephone | 813-719-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3019
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Country | US
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Telephone | 863-680-7000
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Fax | 866-264-8519
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JASON HIRSBRUNNER
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Credential |
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Telephone | 863-680-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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