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General NPI Number Information
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NPI Number | 1851334817
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Entity Type | Individual
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Provider Name | WAYNE H BLAUER MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 1501 HILAND AVE
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City | BURLEY
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State | ID
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Zip | 83318-2688
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Country | US
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Telephone | 208-678-2283
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Fax | 208-677-6059
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Provider Business Mailing Address
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Address Line | PO BOX 30180
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City | SALT LAKE CITY
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State | UT
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Zip | 84130-0180
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Country | US
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Telephone | 208-678-2283
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M4491
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License Number State | ID
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