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General NPI Number Information
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NPI Number | 1750692539
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Entity Type | Individual
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Provider Name | ALEXANDER BLAISE DPM
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Gender | Male
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 3500 NW 17TH AVE
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City | MIAMI
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State | FL
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Zip | 33142-5540
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Country | US
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Telephone | 305-761-1262
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Fax | 306-675-8164
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Provider Business Mailing Address
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Address Line | 9640 NW 10TH CT
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City | PLANTATION
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State | FL
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Zip | 33322-4851
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Country | US
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Telephone | 305-424-9301
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Fax | 305-424-9301
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3526
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License Number State | FL
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