Provider Demographics
NPI:1215114244
Name:WANE, ROBERT S (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:WANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9030 W FORT ISLAND TRL
Mailing Address - Street 2:SUITE #7
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-2412
Mailing Address - Country:US
Mailing Address - Phone:352-795-2142
Mailing Address - Fax:352-795-3044
Practice Address - Street 1:9030 W FORT ISLAND TRL
Practice Address - Street 2:SUITE #7
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-2412
Practice Address - Country:US
Practice Address - Phone:352-795-2142
Practice Address - Fax:352-795-3044
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1141213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55494Medicare UPIN
FL87665Medicare PIN
FL87665AMedicare PIN
FL3852980001Medicare NSC