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General NPI Number Information
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NPI Number | 1932282753
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Entity Type | Individual
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Provider Name | JACQUELINE KELLY FLUD D.O.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 3195 CITRUS TOWER BLVD
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 352-247-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 3195 CITRUS TOWER BLVD
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 352-241-9700
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Fax | 352-241-9784
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OS 9523
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License Number State | FL
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