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General NPI Number Information
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NPI Number | 1629076039
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Entity Type | Individual
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Provider Name | ROXY MARRESE JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 201 N CLYDE MORRIS BLVD SUITE 240
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2724
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Country | US
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Telephone | 386-258-4840
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Fax | 386-255-0140
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Provider Business Mailing Address
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Address Line | 3911 S NOVA RD
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City | PORT ORANGE
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State | FL
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Zip | 32127-4910
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Country | US
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Telephone | 386-258-4840
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Fax | 386-255-0140
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0025420
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License Number State | FL
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