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General NPI Number Information
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NPI Number | 1992723647
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Entity Type | Individual
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Provider Name | TIMOTHY MARTIN SYPEREK D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 8262 POINT MEADOWS DR STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4700
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Country | US
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Telephone | 904-265-0470
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Fax | 904-223-3949
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Provider Business Mailing Address
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Address Line | 705 WELLS RD STE 300
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City | ORANGE PARK
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State | FL
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Zip | 32073-2982
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Country | US
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Telephone | 904-282-6331
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Fax | 904-282-4117
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3414
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO3414
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License Number State | FL
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