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General NPI Number Information
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NPI Number | 1679743454
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Entity Type | Organization
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Legal Business Name | ADVANCED PRACTICE CLINIC LLC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 1184 CIRCLE DR STE B
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-2599
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Country | US
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Telephone | 850-892-2464
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Fax | 850-892-2138
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Provider Business Mailing Address
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Address Line | PO BOX 184
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-0184
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Country | US
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Telephone | 850-892-2464
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Fax | 850-892-2138
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES WILLIAM HOWELL
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Credential | D.O.
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Telephone | 850-892-2464
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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 | OS7047
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License Number State | FL
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