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General NPI Number Information
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NPI Number | 1447070826
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Entity Type | Organization
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Legal Business Name | LLYON MEDICAL, LLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 5205 GREENWOOD AVE STE 213
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2400
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Country | US
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Telephone | 561-203-9747
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Fax |
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Provider Business Mailing Address
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Address Line | 135 WATERVIEW COVE DR
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City | FREEPORT
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State | FL
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Zip | 32439-2810
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Country | US
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Telephone | 850-687-6618
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TIM MARCUS ROBERTS
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Credential |
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Telephone | 850-687-6618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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