=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790765337
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN WAPLES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2006
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3601 CCI DR NW
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35805-2606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-705-4224
-----------------------------------------------------
Fax | 256-705-4135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 18428
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35804-8428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-705-4224
-----------------------------------------------------
Fax | 256-705-4135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 00021807
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------