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General NPI Number Information
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NPI Number | 1629151931
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Entity Type | Individual
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Provider Name | KENNETH MICHAEL PLUMLEY PAC
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5620 CHERRY ST
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City | CALLAWAY
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State | FL
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Zip | 32404
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Country | US
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Telephone | 800-215-7210
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Fax | 850-215-7213
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Provider Business Mailing Address
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Address Line | PO BOX 1568
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City | LYNN HAVEN
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State | FL
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Zip | 32444-1568
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Country | US
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Telephone | 850-769-6612
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Fax | 850-769-3533
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0001942
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License Number State | FL
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