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General NPI Number Information
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NPI Number | 1942317516
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Entity Type | Individual
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Provider Name | SUBHAKARARAO MEDIDI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 14254 STATE ROAD 574 TOM LEE COMMUNITY HEALTH CENTER
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City | DOVER
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State | FL
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Zip | 33527-4312
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Country | US
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Telephone | 813-349-7700
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Fax | 813-349-7761
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Provider Business Mailing Address
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Address Line | 13110 ELK MOUNTAIN DR SUNCOAST COMMUNITY HEALTH CENTERS INC
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City | RIVERVIEW
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State | FL
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Zip | 33579-7182
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Country | US
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Telephone | 813-349-7562
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Fax | 813-349-7561
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME48578
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License Number State | FL
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