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General NPI Number Information
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NPI Number | 1508145251
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Entity Type | Individual
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Provider Name | ROLANDO DOMINGUEZ MUSTAFA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 777 W DUVAL ST
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City | LAKE CITY
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State | FL
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Zip | 32055-5806
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Country | US
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Telephone | 386-755-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 437 SW ROSEMARY DR
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City | LAKE CITY
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State | FL
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Zip | 32024-6715
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Country | US
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Telephone | 973-610-6389
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Fax | 386-719-9013
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME123013
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME123013
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License Number State | FL
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