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General NPI Number Information
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NPI Number | 1902075427
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Entity Type | Organization
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Legal Business Name | CYPRESS MEDICAL
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 877 SW SOUTH MACEDO BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-1815
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Country | US
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Telephone | 772-634-2891
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Fax |
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Provider Business Mailing Address
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Address Line | 2244 SE FEDERAL HWY # 109
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City | STUART
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State | FL
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Zip | 34994-4517
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Country | US
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Telephone | 772-634-2891
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREGORY WAYNE BOWEN
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Credential |
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Telephone | 772-634-2891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | L07000060124
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License Number State | FL
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