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General NPI Number Information
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NPI Number | 1821127929
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE OBGYN CARE OF BCT
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 4959 N STATE ROAD 7 SUITE A
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City | TAMARAC
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State | FL
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Zip | 33319-5871
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Country | US
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Telephone | 754-245-8443
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Fax |
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Provider Business Mailing Address
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Address Line | 4959 N STATE ROAD 7 SUITE A
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City | TAMARAC
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State | FL
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Zip | 33319-5871
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Country | US
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Telephone | 754-245-8443
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LHERISSON DOMOND SR.
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Credential | M.D.
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Telephone | 754-245-8443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME 32051
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License Number State | FL
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