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General NPI Number Information
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NPI Number | 1952446536
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Entity Type | Organization
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Legal Business Name | PATRICK MANGONON MD PA
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 13005 SOUTHERN BLVD SUITE 103
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9206
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Country | US
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Telephone | 561-753-7890
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Fax | 561-753-7775
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Provider Business Mailing Address
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Address Line | PO BOX 210474
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33421-0474
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Country | US
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Telephone | 561-753-7890
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Fax | 561-753-7775
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK T MANGONON
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Credential | MD
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Telephone | 561-753-7890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME77600
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License Number State | FL
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