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General NPI Number Information
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NPI Number | 1750813895
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Entity Type | Individual
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Provider Name | SAMUEL HARRIS D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 12651 W SUNRISE BLVD STE 202
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City | SUNRISE
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State | FL
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Zip | 33323-0906
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Country | US
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Telephone | 954-838-8801
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Fax | 954-838-8807
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Provider Business Mailing Address
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Address Line | 2001 W 68TH ST STE 202
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City | HIALEAH
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State | FL
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Zip | 33016-1801
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Country | US
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Telephone | 305-364-2107
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Fax | 305-822-8347
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS15623
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License Number State | FL
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