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General NPI Number Information
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NPI Number | 1508801036
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Entity Type | Organization
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Legal Business Name | COASTAL FOOT AND ANKLE CLINIC PA.
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 147 W HIGHWAY 98
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City | PORT ST JOE
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State | FL
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Zip | 32456-1871
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Country | US
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Telephone | 850-227-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 894 BACKWATER RD
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City | PORT ST JOE
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State | FL
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Zip | 32456-4984
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Country | US
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Telephone | 850-899-3260
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAMARA A MARSH
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Credential | DPM
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Telephone | 850-899-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO 2869
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License Number State | FL
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