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General NPI Number Information
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NPI Number | 1467445403
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Entity Type | Individual
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Provider Name | BAO TIEN PHAM D.O
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 6816 SOUTHPOINT PKWY SUITE 302
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1700
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Country | US
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Telephone | 904-527-3135
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Fax | 904-683-4293
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Provider Business Mailing Address
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Address Line | 5377 COMMISSIONERS DR
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City | JACKSONVILLE
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State | FL
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Zip | 32224-0830
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Country | US
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Telephone | 904-527-3135
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Fax | 904-683-4293
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | OS7296
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License Number State | FL
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