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General NPI Number Information
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NPI Number | 1619119401
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Entity Type | Individual
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Provider Name | KEVIN PAUL BETHEL M.D. C.M. F.A.A.R.M.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 7949 FAIRWAY BLVD
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City | MIRAMAR
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State | FL
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Zip | 33023-6417
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Country | US
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Telephone | 305-454-1768
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Fax | 242-374-4822
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Provider Business Mailing Address
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Address Line | 10 CORAL ROAD PO BOX F41325
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City | FREEPORT
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State | GRAND BAHAMA
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Zip | 33023
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Country | BS
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Telephone | 242-374-5424
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Fax | 242-374-4822
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | BMC1019
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License Number State | FL
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