MEDICARE: DR. DANIEL S WYZAN MD

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	207RP1001X	Pulmonary Disease Physician	ME48699	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	07238Z	OTHER	FL	BCBS OF FLORIDA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2540584	OTHER	FL	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598781643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL S WYZAN MD

Provider Business Mailing Address
First Line	:	425 NORTH LEE ST
Second Line	:	SUITE 203
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-1128
Country	:	US
Telephone Number	:	904-354-8200
Fax Number	:	904-354-1340

Provider Business Practice Location Address
First Line	:	425 NORTH LEE ST
Second Line	:	SUITE 203
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-1128
Country	:	US
Telephone Number	:	904-354-8200
Fax Number	:	904-354-1340

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/28/2014

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