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General NPI Number Information
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NPI Number | 1760167233
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Entity Type | Organization
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Legal Business Name | BLUE WAVE MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1822 DREW ST
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City | CLEARWATER
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State | FL
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Zip | 33765-2921
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Country | US
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Telephone | 917-576-7624
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 S FORT HARRISON AVE
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City | CLEARWATER
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State | FL
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Zip | 33756-3907
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Country | US
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Telephone | 727-303-3117
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Fax | 727-335-4430
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Authorized Official
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Title or Position | OWNER
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Name | DR. AUDREY Z PAUL
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Credential | MD
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Telephone | 917-576-7624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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