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General NPI Number Information
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NPI Number | 1508312687
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Entity Type | Organization
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Legal Business Name | LOWER EXTREMITY SPECIALISTS LLC
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 2500 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-5750
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Country | US
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Telephone | 305-301-0005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 152545
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City | CAPE CORAL
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State | FL
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Zip | 33915-2545
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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 | SOLE PROPRIETOR
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Name | EDWARD GONZALEZ
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Credential | D.P.M.
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Telephone | 305-301-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3451
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License Number State | FL
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