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General NPI Number Information
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NPI Number | 1619244555
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Entity Type | Organization
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Legal Business Name | DOUGLAS VASCULAR CENTER, LLC
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 326 SHIRLEY AVE
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City | DOUGLAS
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State | GA
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Zip | 31533-2332
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Country | US
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Telephone | 727-474-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 PALM HARBOR BLVD STE A
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City | PALM HARBOR
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State | FL
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Zip | 34683-1930
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Country | US
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Telephone | 727-474-0090
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Fax | 727-474-0055
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. JANET R DEES
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Credential | MANAGING MEMBER
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Telephone | 727-474-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 11081332
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License Number State | FL
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