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General NPI Number Information
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NPI Number | 1578727970
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Entity Type | Individual
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Provider Name | ALLISON H MABUS MD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 2851 COUNTY ROAD 210 W. SUITE 122
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City | FRUITE COVE
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State | FL
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Zip | 32259-4080
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Country | US
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Telephone | 904-450-8120
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Fax | 904-450-8119
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Provider Business Mailing Address
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Address Line | 2851 COUNTY ROAD 210 W. SUITE 122
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City | FRUITE COVE
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State | FL
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Zip | 32259-4080
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Country | US
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Telephone | 904-450-8120
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Fax | 904-450-8119
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TRN 13081
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License Number State | FL
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