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General NPI Number Information
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NPI Number | 1528010923
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Entity Type | Organization
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Legal Business Name | CENTER FOR MEDICINE AND PSYCHIATRY
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1408 SAN MARCO BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8536
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Country | US
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Telephone | 904-398-0009
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Fax | 904-346-0887
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Provider Business Mailing Address
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Address Line | PO BOX 10339
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City | JACKSONVILLE
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State | FL
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Zip | 32247-0339
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Country | US
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Telephone | 904-398-0009
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Fax | 904-346-0887
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMED O SALEH
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Credential | M.D.
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Telephone | 904-398-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0043827
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License Number State | FL
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