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General NPI Number Information
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NPI Number | 1497198816
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Entity Type | Organization
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Legal Business Name | SUNSHINE DOCTORS GROUP. LLC
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 3531 SW CORPORATE PARKWAY ROOM 1
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City | PALM CITY
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State | FL
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Zip | 34990
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Country | US
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Telephone | 772-872-6025
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Fax | 772-872-6128
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Provider Business Mailing Address
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Address Line | PO BOX 733154
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City | DALLAS
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State | TX
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Zip | 75373-3154
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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 | CHIEF ADMINISTRATIVE OFFICER
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Name | MR. EDWARD ROUSSEAU
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Credential |
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Telephone | 772-266-7682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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