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General NPI Number Information
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NPI Number | 1629517917
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Entity Type | Organization
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Legal Business Name | EVOLVE PODIATRY LLC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 825 E BURGESS RD
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City | PENSACOLA
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State | FL
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Zip | 32504-7001
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Country | US
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Telephone | 850-359-6329
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Fax | 888-375-3009
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Provider Business Mailing Address
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Address Line | PO BOX 6527
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City | PENSACOLA
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State | FL
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Zip | 32503-0527
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Country | US
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Telephone | 850-359-6329
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Fax | 888-375-3009
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY T WEILAND
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Credential | DPM
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Telephone | 847-899-0215
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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 |
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License Number State |
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