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General NPI Number Information
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NPI Number | 1710203435
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Entity Type | Individual
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Provider Name | JESSE BALSEIRO MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 4348 SOUTHPOINT BLVD SUITE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0986
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Country | US
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Telephone | 904-281-1915
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Fax | 904-281-1119
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Provider Business Mailing Address
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Address Line | 7224-1 MERRILL RD
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City | JACKSONVILLE
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State | FL
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Zip | 32277-3725
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Country | US
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Telephone | 407-798-8800
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Fax | 321-333-4292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | ME103629
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME103629
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License Number State | FL
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