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General NPI Number Information
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NPI Number | 1669437091
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Entity Type | Organization
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Legal Business Name | PETER L. FORT, MD PA
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 5955 17TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-7836
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Country | US
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Telephone | 941-794-3900
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Fax | 941-794-8810
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Provider Business Mailing Address
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Address Line | 5955 17TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-7836
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Country | US
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Telephone | 941-794-3900
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Fax | 941-794-8810
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER L. FORT
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Credential | M.D.
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Telephone | 941-794-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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