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General NPI Number Information
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NPI Number | 1215992219
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Entity Type | Individual
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Provider Name | DANIEL OWEN WYMAN MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 113 LIELMANIS AVE
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City | HURLBURT FIELD
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State | FL
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Zip | 32544-5613
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Country | US
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Telephone | 850-884-2269
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Fax |
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Provider Business Mailing Address
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Address Line | 227 WINDWARD WAY
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City | NICEVILLE
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State | FL
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Zip | 32578-4306
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Country | US
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Telephone | 850-897-4849
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD042125E
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License Number State | PA
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