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General NPI Number Information
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NPI Number | 1710688387
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Entity Type | Individual
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Provider Name | DEXTER PAUL LUMAQUE
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Gender | Male
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 5918 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32503-2050
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Country | US
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Telephone | 850-828-8759
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 SUMMIT BLVD
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City | PENSACOLA
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State | FL
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Zip | 32503-5154
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Country | US
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Telephone | 850-368-0235
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Fax |
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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 | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | PT29104
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License Number State | FL
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