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General NPI Number Information
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NPI Number | 1578696159
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Entity Type | Organization
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Legal Business Name | SETH B FORMAN MD PL
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 3622 MADACA LN
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City | TAMPA
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State | FL
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Zip | 33618-2057
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Country | US
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Telephone | 813-960-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 3622 MADACA LN
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City | TAMPA
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State | FL
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Zip | 33618-2057
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Country | US
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Telephone | 813-960-2400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SETH B FORMAN
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Credential | MD
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Telephone | 813-960-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME96509
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License Number State | FL
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