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Individual
Inactive
Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
41159
CO
207R00000X
Internal Medicine Physician
Primary
60433
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014382600
—
FL
Enumeration date
—
Last updated
—
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