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General NPI Number Information
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NPI Number | 1851680789
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Entity Type | Organization
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Legal Business Name | GULFVIEW MEDICAL INSTITUTE PLLC
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 21942 EDGEWATER DR
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9723
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Country | US
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Telephone | 941-505-2100
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Fax | 941-505-6100
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Provider Business Mailing Address
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Address Line | 21942 EDGEWATER DR STE 1211
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9723
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Country | US
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Telephone | 941-505-2100
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Fax | 941-505-6100
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH RAVID
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Credential | MD
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Telephone | 941-505-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 106244
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License Number State | FL
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