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General NPI Number Information
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NPI Number | 1932103397
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Entity Type | Individual
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Provider Name | JOSEPH R AGOSTINELLI DPM PA
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 1034 MAR WALT DR STE 100
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6645
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Country | US
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Telephone | 850-863-2153
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Fax | 850-315-9350
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Provider Business Mailing Address
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Address Line | 1034 MAR WALT DR STE 100
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6645
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Country | US
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Telephone | 850-863-2153
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Fax | 850-315-9350
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2643
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License Number State | FL
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