MEDICARE: DR. ROBERT S. WANE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO 1141	FL

General Provider Information

NPI Number	:	1215114244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT S. WANE DPM

Provider Business Mailing Address
First Line	:	9030 W FORT ISLAND TRL
Second Line	:	SUITE #7
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-2412
Country	:	US
Telephone Number	:	352-795-2142
Fax Number	:	352-795-3044

Provider Business Practice Location Address
First Line	:	9030 W FORT ISLAND TRL
Second Line	:	SUITE #7
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-2412
Country	:	US
Telephone Number	:	352-795-2142
Fax Number	:	352-795-3044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	03/31/2008

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Directions to “ DR. ROBERT S. WANE DPM” Practice Location

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