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General NPI Number Information
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NPI Number | 1790806248
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Entity Type | Individual
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Provider Name | TWAN PHANIJPHAND D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 1326 LEWIS TURNER BLVD
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1139
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Country | US
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Telephone | 850-601-8177
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Fax | 850-862-0605
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Provider Business Mailing Address
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Address Line | 1326 LEWIS TURNER BLVD
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1139
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Country | US
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Telephone | 850-601-8177
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Fax | 850-862-0605
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | OS16137
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 5101015350
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2010014123
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License Number State | MO
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