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General NPI Number Information
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NPI Number | 1487185567
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Entity Type | Individual
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Provider Name | JACOB JAMES BENEDICT M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 24 DEL PRADO BLVD N
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City | CAPE CORAL
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State | FL
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Zip | 33909-2780
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Country | US
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Telephone | 239-939-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 39 BARKLEY CIR
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City | FORT MYERS
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State | FL
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Zip | 33907-7531
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Country | US
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Telephone |
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Fax |
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME154987
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License Number State | FL
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