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General NPI Number Information
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NPI Number | 1487837480
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Entity Type | Organization
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Legal Business Name | EDWARD GLAVEY D O LLC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 575 E CENTRAL AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3054
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Country | US
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Telephone | 863-299-5424
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Fax | 863-647-2410
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Provider Business Mailing Address
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Address Line | PO BOX 3293
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City | APOLLO BEACH
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State | FL
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Zip | 33572-1000
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Country | US
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Telephone | 863-299-5424
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Fax | 863-647-2410
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. EDWARD J GLAVEY III
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Credential | DO
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Telephone | 863-299-5424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS10216
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License Number State | FL
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