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General NPI Number Information
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NPI Number | 1770818601
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF MEDICAL EXCELLENCE
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 101 MICROSPINE WAY
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435
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Country | US
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Telephone | 850-892-4248
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1262
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-1262
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Country | US
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Telephone | 850-892-4248
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KINLEY WAYNE HOWARD
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Credential | DPM, CRNA
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Telephone | 850-892-4248
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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 | PO2112
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP2539562
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License Number State | FL
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