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General NPI Number Information
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NPI Number | 1750685111
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Entity Type | Organization
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Legal Business Name | EAST ATLANTIC SPECIALTY MANAGEMENT GROUP LLC
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 4600 LINTON BLVD STE 100
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6600
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Country | US
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Telephone | 561-791-1836
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 LINTON BLVD SUITE 100
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EUGENIO RODRIGUEZ
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Credential | MD
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Telephone | 561-381-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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