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General NPI Number Information
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NPI Number | 1629106950
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Entity Type | Individual
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Provider Name | ROY E SCUDAMORE CERT. PROSTHETIST
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 S DIVISION AVE
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City | ORLANDO
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State | FL
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Zip | 32805-4715
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Country | US
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Telephone | 407-843-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 4702 NW 80TH COURT
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City | OCALA
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State | FL
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Zip | 34482
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Country | US
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Telephone | 352-840-0995
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Fax |
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | PRO88
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License Number State | FL
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