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General NPI Number Information
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NPI Number | 1841775087
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Entity Type | Individual
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Provider Name | KELLY MASON DAVIS
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Gender | Female
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 1336 SAINT ANDREWS BLVD
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City | PANAMA CITY
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State | FL
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Zip | 32405-2762
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Country | US
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Telephone | 850-763-3911
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 VERMONT AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-3566
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Country | US
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Telephone | 850-814-5456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 22229
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License Number State | FL
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