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General NPI Number Information
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NPI Number | 1679583769
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Entity Type | Organization
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Legal Business Name | LAWRENCE E BRODER M D P A
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 45 NW 8TH ST SUITE 104
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City | HOMESTEAD
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State | FL
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Zip | 33030-4452
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Country | US
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Telephone | 305-246-5500
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Fax | 305-246-0081
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Provider Business Mailing Address
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Address Line | 8740 SW 182ND TER
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City | VILLAGE OF PALMETTO BAY
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State | FL
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Zip | 33157-5952
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Country | US
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Telephone | 305-238-1212
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Fax | 305-238-8191
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE BRODER
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Credential |
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Telephone | 305-238-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | ME0027628
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License Number State | FL
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