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General NPI Number Information
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NPI Number | 1487909768
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Entity Type | Individual
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Provider Name | STEVEN TODD WILFONG
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Gender | Male
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 8491 SE 165TH MULBERRY LN
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City | THE VILLAGES
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State | FL
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Zip | 32162-5847
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Country | US
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Telephone | 352-259-8157
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Fax | 352-753-6415
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Provider Business Mailing Address
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Address Line | 40233 SHERYDAN GLENN
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City | LADY LAKE
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State | FL
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Zip | 32159-2819
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Country | US
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Telephone | 352-259-8157
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Fax | 352-753-6415
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS4838
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License Number State | FL
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