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General NPI Number Information
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NPI Number | 1699344614
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Entity Type | Organization
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Legal Business Name | ADVANCED FOOT AND ANKLE OF VIRGINIA PLLC
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 5231 HICKORY PARK DR STE D
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City | GLEN ALLEN
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State | VA
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Zip | 23059-2619
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Country | US
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Telephone | 804-390-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 THE FRST
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City | CROZIER
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State | VA
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Zip | 23039-2421
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Country | US
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Telephone | 804-709-7141
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN, MEDICAL DIRECTOR
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Name | DR. RYAN VAZALES
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Credential | DPM
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Telephone | 804-390-9879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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