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General NPI Number Information
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NPI Number | 1578797676
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Entity Type | Individual
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Provider Name | ABDO BACHOURA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 17270 SE 109TH TERRACE RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-9015
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Country | US
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Telephone | 352-336-6000
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Fax |
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Provider Business Mailing Address
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Address Line | HQ101 UNIV OF KY 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-0001
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Country | US
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Telephone | 617-800-3390
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME141396
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | ME141396
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License Number State | FL
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