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General NPI Number Information
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NPI Number | 1760719702
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Entity Type | Organization
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Legal Business Name | MOHAMMAD BASIL AMIN MD PA
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 800 PRUDENTIAL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8202
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Country | US
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Telephone | 904-446-6666
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2261
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City | ORANGE PARK
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State | FL
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Zip | 32067-2261
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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 | OWNER
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Name | MOHAMMAD B AMIN
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Credential | MD
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Telephone | 904-446-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME72588
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License Number State | FL
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