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General NPI Number Information
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NPI Number | 1437768033
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Entity Type | Organization
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Legal Business Name | COASTAL INJURY CLINIC LLC
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 2700 RIVERSIDE AVE STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32205-8233
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Country | US
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Telephone | 904-559-6638
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Fax | 888-927-0401
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Provider Business Mailing Address
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Address Line | PO BOX 1869
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City | ORANGE PARK
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State | FL
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Zip | 32067-1869
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Country | US
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Telephone | 904-559-6638
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Fax | 888-927-0401
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Authorized Official
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Title or Position | CEO
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Name | ANDREW T CHRISTMAN
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Credential |
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Telephone | 941-685-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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