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General NPI Number Information
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NPI Number | 1609000215
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Entity Type | Organization
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Legal Business Name | PETER A. NASSAR, M.D., P.A.
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 6930 BONNEVAL RD SUITE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6084
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Country | US
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Telephone | 904-854-6899
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Fax | 904-338-0533
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Provider Business Mailing Address
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Address Line | 3537 CREST ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3801
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Country | US
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Telephone | 904-236-9331
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Fax | 904-338-0533
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER A NASSAR
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Credential | MD
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Telephone | 904-236-9331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME94669
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | ME94669
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License Number State | FL
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