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General NPI Number Information
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NPI Number | 1821254277
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Entity Type | Organization
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Legal Business Name | LARRY L MACKALL MD LLC
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 605 UNITED ST SUITE B
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City | KEY WEST
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State | FL
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Zip | 33040-3229
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Country | US
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Telephone | 305-296-0400
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Fax | 305-293-4683
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Provider Business Mailing Address
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Address Line | 605 UNITED ST SUITE B
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City | KEY WEST
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State | FL
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Zip | 33040-3229
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Country | US
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Telephone | 305-296-0400
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Fax | 305-293-4683
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. LARRY L. MACKALL
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Credential | M.D.
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Telephone | 305-296-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME50055
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License Number State | FL
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