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General NPI Number Information
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NPI Number | 1699081356
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Entity Type | Organization
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Legal Business Name | GIANCARLO BERTOZZI MD PA
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 3599 UNIVERSITY BLVD S STE 802
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4258
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Country | US
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Telephone | 904-396-2421
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Fax | 904-398-1854
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Provider Business Mailing Address
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Address Line | 3599 UNIVERSITY BLVD S STE 802
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4258
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Country | US
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Telephone | 904-396-2421
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Fax | 904-398-1854
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Authorized Official
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Title or Position | PHYSICIAN/SURGEON/OWNER
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Name | GIANCARLO BERTOZZI
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Credential | MD
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Telephone | 904-396-2421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME 20514
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License Number State | FL
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