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General NPI Number Information
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NPI Number | 1689446023
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Entity Type | Organization
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Legal Business Name | TRINITY FOOT AND ANKLE PLLC
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 2439 COUNTRY PLACE BLVD
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City | TRINITY
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State | FL
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Zip | 34655-1104
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Country | US
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Telephone | 727-376-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 2439 COUNTRY PLACE BLVD
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City | TRINITY
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State | FL
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Zip | 34655-1104
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Country | US
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Telephone | 727-376-3338
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EVAN YOUNG
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Credential | DPM
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Telephone | 309-532-2543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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