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General NPI Number Information
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NPI Number | 1467405779
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Entity Type | Individual
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Provider Name | THOMAS W WULF M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 607 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5211
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Country | US
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Telephone | 575-208-7795
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Fax | 575-208-7785
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Provider Business Mailing Address
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Address Line | 607 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5211
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Country | US
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Telephone | 575-208-7795
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Fax | 575-208-7785
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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 | MD2005-0529
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207LH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Anesthesiology) Physician
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License Number | MD2005-0529
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License Number State | NM
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