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General NPI Number Information
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NPI Number | 1619341039
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 1409 KINGSLEY AVE SUITE 9G
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City | ORANGE PARK
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State | FL
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Zip | 32073-4537
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Country | US
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Telephone | 904-637-0037
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Fax | 904-639-6017
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Provider Business Mailing Address
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Address Line | 396 N LOMBARDY LOOP
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City | JACKSONVILLE
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State | FL
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Zip | 32259-5266
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMAN SOLEYMANI
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Credential | MD
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Telephone | 904-962-7396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME88018
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License Number State | ZZ
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