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General NPI Number Information
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NPI Number | 1912982802
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Entity Type | Individual
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Provider Name | MARK L PERMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 2107 SE OCEAN BLVD
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City | STUART
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State | FL
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Zip | 34996-3305
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Country | US
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Telephone | 772-403-2390
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Fax | 772-403-2395
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | FLME59298
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME59298
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License Number State | FL
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