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General NPI Number Information
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NPI Number | 1285892729
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Entity Type | Individual
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Provider Name | RYAN SCOTT WADE DO
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Gender | Male
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Dates
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Enumeration Date | 05/31/2008
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 1050 E SOUTH TEMPLE DEPARTMENT OF ANESTHESIA
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1507
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Country | US
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Telephone | 801-350-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 SANTA ANITA DR
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City | KAYSVILLE
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State | UT
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Zip | 84037-6780
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Country | US
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Telephone | 801-510-1411
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 8209956-1204
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License Number State | UT
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