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General NPI Number Information
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NPI Number | 1598758278
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Entity Type | Individual
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Provider Name | ROBERT A IANNACONE DPM, P.A.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 691 SW PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-1998
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Country | US
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Telephone | 772-878-0040
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Fax | 772-878-4265
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Provider Business Mailing Address
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Address Line | 691 SW PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-1998
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Country | US
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Telephone | 772-878-0040
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Fax | 778-878-4265
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO0002344
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License Number State | FL
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