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General NPI Number Information
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NPI Number | 1710959622
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Entity Type | Individual
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Provider Name | JOSE LUIS LIZARDI PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 2330 NORTH BLVD W
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City | DAVENPORT
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State | FL
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Zip | 33837-8989
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Country | US
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Telephone | 407-931-0444
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Fax | 407-962-4446
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Provider Business Mailing Address
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Address Line | PO BOX 44008 UFJP WINTER HAVEN
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-3199
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Fax | 904-244-3425
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA3731
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License Number State | FL
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