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General NPI Number Information
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NPI Number | 1861717092
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Entity Type | Individual
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Provider Name | PAUL E ROA MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVE STE 314
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City | MIRAMAR
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State | FL
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Zip | 33029
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Country | US
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Telephone | 549-447-5206
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Fax | 954-447-5259
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Provider Business Mailing Address
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Address Line | 1951 SW 172ND AVE STE 314
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City | MIRAMAR
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State | FL
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Zip | 33029-5614
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Country | US
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Telephone | 549-447-5206
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Fax | 954-447-5259
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME123129
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License Number State | FL
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