Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101054459 | VA |
N | 2081P2900X | Pain Medicine | 0101054459 | VA |
NPI | 1124027305 |
---|---|
Provider Name | Daren Murray Wingard |
First Address | Virginia Beach, VA 23450-2546 |
Second Address | Virginia Beach, VA 23455-5545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006802885 | (05) | VA |
H59903 | (02) | |
W7093367 | DEA (01) | VA |