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General NPI Number Information
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NPI Number | 1023071347
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Entity Type | Individual
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Provider Name | JOHN DAVID WILKES MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 400 MEDICAL PLZ SUITE 100
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1490
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Country | US
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Telephone | 636-639-8600
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Fax | 636-639-8676
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Provider Business Mailing Address
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Address Line | 500 MEDICAL DRIVE
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City | WENTZVILLE
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State | MO
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Zip | 63385
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Country | US
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Telephone | 636-327-1202
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Fax | 636-327-1222
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R7J99
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License Number State | MO
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