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General NPI Number Information
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NPI Number | 1588823389
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Entity Type | Organization
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Legal Business Name | BLUE OCEAN HEALTHCARE PHYSICIANS GROUP
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 21300 GERTRUDE AVE SUITE 1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5018
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Country | US
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Telephone | 941-743-3311
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Fax | 941-743-3313
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Provider Business Mailing Address
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Address Line | 21300 GERTRUDE AVE SUITE 1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5018
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Country | US
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Telephone | 941-743-3311
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Fax | 941-743-3313
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE JOANNE SHELL
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Credential | DO
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Telephone | 941-743-3311
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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 | OS8267
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License Number State | FL
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