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General NPI Number Information
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NPI Number | 1619249927
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Entity Type | Organization
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Legal Business Name | MD PROFESSIONAL GROUP CORP
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 1235 N KROME AVE R
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City | HOMESTEAD
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State | FL
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Zip | 33030-4204
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Country | US
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Telephone | 305-242-9952
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Fax | 305-242-9998
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Provider Business Mailing Address
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Address Line | 1235 N KROME AVE R
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City | HOMESTEAD
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State | FL
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Zip | 33030-4204
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Country | US
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Telephone | 305-242-9952
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Fax | 305-242-9998
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Authorized Official
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Title or Position | PRES CEO
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Name | MR. LAZARO MOREIRA
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Credential |
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Telephone | 305-242-9952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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