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General NPI Number Information
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NPI Number | 1558307835
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Entity Type | Individual
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Provider Name | EFREN CARBONELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 401 CECIL G COSTIN SR BLVD
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City | PORT ST JOE
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State | FL
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Zip | 32456-1928
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Country | US
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Telephone | 850-229-1043
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Fax | 850-229-1104
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Provider Business Mailing Address
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Address Line | 403 E 11TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32401-3409
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Country | US
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Telephone | 850-747-5599
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Fax | 850-872-4131
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 12359
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 12359
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN262
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License Number State | FL
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