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General NPI Number Information
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NPI Number | 1629222146
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Entity Type | Organization
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Legal Business Name | DELANEY PARK FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 900 DELANEY AVE
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City | ORLANDO
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State | FL
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Zip | 32806-1246
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Country | US
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Telephone | 407-423-2571
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Fax | 407-423-0028
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Provider Business Mailing Address
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Address Line | 1495 S VOLUSIA AVE SUITE 102
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City | ORANGE CITY
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State | FL
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Zip | 32763-7047
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Country | US
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Telephone | 386-774-5211
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Fax | 386-774-5251
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE D PORTER
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Credential | M.D.
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Telephone | 407-423-2571
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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 | ME12701
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License Number State | FL
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