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General NPI Number Information
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NPI Number | 1972801827
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Entity Type | Organization
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Legal Business Name | LAKE GASTROENTEROLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 1703 MAYO DR
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City | TAVARES
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State | FL
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Zip | 32778-4307
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Country | US
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Telephone | 352-383-5200
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Fax | 352-383-3534
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Provider Business Mailing Address
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Address Line | PO BOX 1345
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City | MOUNT DORA
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State | FL
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Zip | 32756-1345
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Country | US
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Telephone | 352-383-5200
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Fax | 352-383-3534
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Authorized Official
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Title or Position | OWNER/OFFICER
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Name | SOUNDARAPANDIAN BASKAR
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Credential | MD
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Telephone | 352-636-3652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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