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General NPI Number Information
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NPI Number | 1992906432
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Entity Type | Individual
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Provider Name | ALEX VINCENT FUNICELLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 5996 SW 70TH ST FL 5
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3540
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Country | US
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Telephone | 305-284-7655
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Fax | 305-284-7763
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Provider Business Mailing Address
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Address Line | 8060 SANCTUARY DR UNIT 1
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City | NAPLES
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State | FL
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Zip | 34104-5998
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Country | US
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Telephone | 914-584-8257
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Fax |
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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 | ME98852
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME98852
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License Number State | FL
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