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General NPI Number Information
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NPI Number | 1821516683
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Entity Type | Organization
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Legal Business Name | A REVOLUTION MEDICAL
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 711 N ORLANDO AVE
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City | MAITLAND
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State | FL
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Zip | 32751-4403
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Country | US
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Telephone | 407-636-5391
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Fax | 407-986-4404
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Provider Business Mailing Address
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Address Line | 711 N ORLANDO AVE
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City | MAITLAND
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State | FL
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Zip | 32751-4403
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Country | US
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Telephone | 407-636-5391
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Fax | 407-986-4404
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Authorized Official
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Title or Position | MGR
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Name | DR. ROBERT G CARDER
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Credential | DOM
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Telephone | 407-808-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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