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1508353764
JACOB AVRAM BOOMGAARDT
CHARLOTTESVILLE, VA
NPI
1508353764
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2018-04-13
Last Update Date
2018-04-13
Business Address
JACOB AVRAM BOOMGAARDT DO
1215 LEE ST
CHARLOTTESVILLE, VA 22908-0816
Phone number: 434-924-3627
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Mailing Address
JACOB AVRAM BOOMGAARDT DO
8141 SW 24TH CT APT 205
DAVIE, FL 33324-5719
Phone number: 954-599-2199
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