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General NPI Number Information
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NPI Number | 1568541449
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Entity Type | Organization
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Legal Business Name | ROBERT S WANE DPM PA
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 03/16/2008
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Provider Practice Location Address
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Address Line | 9030 WEST FORT ISLAND TRAIL SUITE 7
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429
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Country | US
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Telephone | 352-795-2142
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Fax | 352-795-3044
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Provider Business Mailing Address
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Address Line | 9030 WEST FORT ISLAND TRAIL SUITE 7
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429
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Country | US
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Telephone | 352-795-2142
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Fax | 352-795-3044
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Authorized Official
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Title or Position | PRES OF PA
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Name | DR. ROBERT S WANE
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Credential | DPM
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Telephone | 352-795-2142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO1141
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License Number State | FL
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