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General NPI Number Information
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NPI Number | 1811389950
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Entity Type | Organization
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Legal Business Name | MOBILE PVD, LLC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 3109 STIRLING RD 100-B
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6558
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Country | US
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Telephone | 954-315-2002
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Fax | 954-337-2402
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Provider Business Mailing Address
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Address Line | 3109 STIRLING RD 100-B
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6558
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Country | US
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Telephone | 954-315-2002
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Fax | 954-337-2402
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Authorized Official
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Title or Position | CEO
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Name | MATTHEW ROGERS
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Credential |
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Telephone | 914-912-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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