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General NPI Number Information
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NPI Number | 1942504055
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Entity Type | Organization
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Legal Business Name | ST. VINCENT'S INTENSIVISTS, LLC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 1 SHIRCLIFF WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4748
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Country | US
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Telephone | 904-354-8200
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Fax | 904-354-1340
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Provider Business Mailing Address
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Address Line | 425 N LEE ST SUITE 203
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1127
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Country | US
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Telephone | 904-354-8200
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Fax | 904-354-1340
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL WYZAN
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Credential | M.D.
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Telephone | 904-354-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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