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General NPI Number Information
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NPI Number | 1124308580
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Entity Type | Individual
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Provider Name | WOLF KARL VON WAAGNER MD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2306 NORTH BLVD W STE C
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City | DAVENPORT
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State | FL
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Zip | 33837-8976
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Country | US
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Telephone | 863-547-9200
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Fax | 863-547-9221
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Provider Business Mailing Address
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Address Line | 423 RARITAN AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-2345
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Country | US
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Telephone | 718-755-8882
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME170625
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License Number State | FL
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