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General NPI Number Information
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NPI Number | 1841008398
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Entity Type | Organization
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Legal Business Name | VISTA DORO ANESTHESIA, LLC
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 201 S A ST
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City | PENSACOLA
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State | FL
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Zip | 32502-5554
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Country | US
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Telephone | 318-572-5474
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Fax |
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Provider Business Mailing Address
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Address Line | 512 EVENTIDE DR
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City | GULF BREEZE
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State | FL
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Zip | 32561-4875
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Country | US
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Telephone | 318-572-5474
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARTIC R SMITH
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Credential | CRNA
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Telephone | 318-572-5474
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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 |
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License Number State |
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