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General NPI Number Information
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NPI Number | 1598084063
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Entity Type | Individual
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Provider Name | ANDREW WILSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 6600 MADISON ST
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-1971
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Country | US
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Telephone | 727-838-6186
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DAVIS BLVD SUITE 504
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City | TAMPA
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State | FL
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Zip | 33606-3463
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Country | US
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Telephone | 813-627-5931
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME116018
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License Number State | FL
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