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General NPI Number Information
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NPI Number | 1891791588
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Entity Type | Individual
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Provider Name | ANTHONY DANIEL VILLARE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 800 WEST AVE S
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City | LA CROSSE
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State | WI
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Zip | 54601-8806
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Country | US
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Telephone | 608-785-0940
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1510
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City | EAU CLAIRE
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State | WI
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Zip | 54702-1510
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Country | US
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Telephone | 715-838-3635
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 53465
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 53465
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License Number State | WI
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