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General NPI Number Information
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NPI Number | 1518130509
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Entity Type | Organization
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Legal Business Name | FIRST FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 320 1ST ST S SUITE 200
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3501
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Country | US
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Telephone | 863-294-6132
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Fax | 863-293-8450
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Provider Business Mailing Address
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Address Line | 320 1ST ST S STE 200 SUITE 200
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3501
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Country | US
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Telephone | 863-294-6132
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Fax | 863-293-8450
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TOMMY L LOUISVILLE
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Credential | M.D.
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Telephone | 863-294-6132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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