Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 09575 | MS |
NPI | 1104925882 |
---|---|
Provider Name | David F Wender |
First Address | Flowood, MS 39232 |
Second Address | Flowood, MS 39232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 17/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00122948 | (05) | MS |
0122948 | (05) | MS |
09575 | MS STATE MEDICAL LIC (01) | MS |