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General NPI Number Information
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NPI Number | 1851618797
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Entity Type | Individual
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Provider Name | DIANE ANTOINETTE THOMPSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 901 45TH ST
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City | MANGONIA PARK
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State | FL
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Zip | 33407-2413
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Country | US
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Telephone | 561-882-6494
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Fax | 561-841-9953
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Provider Business Mailing Address
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Address Line | 700 S ROSEMARY AVE STE 204
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6310
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Country | US
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Telephone | 917-250-3380
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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 | 2081P0301X
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Taxonomy Name | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME161062
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 273447
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License Number State | NY
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