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General NPI Number Information
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NPI Number | 1659541340
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Entity Type | Organization
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Legal Business Name | SOUTH WALTON MEDICAL CENTER INC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 10005C US HIGHWAY 98 W
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City | DESTIN
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State | FL
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Zip | 32550-4962
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Country | US
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Telephone | 850-837-8005
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Fax | 850-837-4352
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Provider Business Mailing Address
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Address Line | 10005C US HIGHWAY 98 W
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City | DESTIN
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State | FL
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Zip | 32550-4962
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Country | US
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Telephone | 850-837-8005
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Fax | 850-837-4352
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | RONALD BRUCE CAUSTON
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Credential | MD
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Telephone | 850-837-8005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | FLME43330
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License Number State | FL
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