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General NPI Number Information
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NPI Number | 1861660029
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Entity Type | Organization
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Legal Business Name | V P JEYABARATH MD PA
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 17222 HOSPITAL BLVD STE 116
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City | BROOKSVILLE
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State | FL
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Zip | 34601-8925
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Country | US
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Telephone | 352-754-0500
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Fax | 352-754-0515
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Provider Business Mailing Address
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Address Line | PO BOX 12399
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City | BROOKSVILLE
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State | FL
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Zip | 34603-2399
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Country | US
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Telephone | 352-754-0500
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Fax | 352-754-0515
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Authorized Official
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Title or Position | OWNER - PROVIDER
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Name | VINAITHEERTHA P JEYABARATH
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Credential | MD
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Telephone | 352-754-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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