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General NPI Number Information
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NPI Number | 1821270380
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Entity Type | Organization
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Legal Business Name | JUDE MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 2700 E BAY DR STE 101
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City | LARGO
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State | FL
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Zip | 33771-2468
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Country | US
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Telephone | 727-531-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 E BAY DR STE 101
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City | LARGO
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State | FL
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Zip | 33771-2468
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Country | US
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Telephone | 727-531-6700
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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 | KAYODE SOTONWA
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Credential | M.D.
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Telephone | 727-531-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME90545
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License Number State | FL
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