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General NPI Number Information
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NPI Number | 1245222322
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Entity Type | Individual
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Provider Name | CODY KEITH WASNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 1007 HARLOW RD STE 210
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City | SPRINGFIELD
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State | OR
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Zip | 97477-7126
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Country | US
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Telephone | 541-741-0387
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Fax | 541-242-4634
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Provider Business Mailing Address
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Address Line | PO BOX 1648
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City | EUGENE
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State | OR
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Zip | 97440-1648
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Country | US
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Telephone | 541-242-4384
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Fax | 541-463-2820
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 12537
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License Number State | OR
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