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General NPI Number Information
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NPI Number | 1790875565
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Entity Type | Organization
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Legal Business Name | VEIN CLINIC OF THE PALM BEACHES LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 115 NE 3RD ST SUITE B&C
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2901
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Country | US
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Telephone | 863-357-0888
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Fax | 863-357-1330
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Provider Business Mailing Address
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Address Line | 115 NE 3RD ST SUITE B&C
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2901
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Country | US
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Telephone | 863-357-0888
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Fax | 863-357-1330
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUIS R ROSAS
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Credential | MD
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Telephone | 615-507-2283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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