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General NPI Number Information
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NPI Number | 1508943762
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC BREAST CENTER
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2161 PALM BEACH LAKES BLVD SUITE 100
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6607
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Country | US
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Telephone | 561-478-0101
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Fax | 561-478-2085
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Provider Business Mailing Address
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Address Line | 2161 PALM BEACH LAKES BLVD SUITE 100
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6607
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Country | US
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Telephone | 561-478-0101
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Fax | 561-478-2085
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BARRY K SIMON
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Credential | MD
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Telephone | 561-478-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME31919
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License Number State | FL
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