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Individual
PREM FORT
Active
Individual
PREM FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
ME123447
FL
Other
Enumeration date
05/01/2008
Last updated
06/24/2016
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