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General NPI Number Information
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NPI Number | 1245378819
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Entity Type | Individual
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Provider Name | HARLEY M. WISHNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 22540 DARDENNE ST SUITE 200
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City | CALABASAS
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State | CA
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Zip | 91302-5823
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Country | US
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Telephone | 818-231-1440
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Fax | 818-225-1572
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Provider Business Mailing Address
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Address Line | PO BOX 8040
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City | CALABASAS
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State | CA
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Zip | 91372-8040
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Country | US
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Telephone | 818-231-1440
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Fax | 818-225-1572
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | G38891
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License Number State | CA
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