Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | R8C78 | MO |
NPI | 1043205750 |
---|---|
Provider Name | David H Wuellner |
First Address | Sedalia, MO 65301-7542 |
Second Address | Sedalia, MO 65301-7542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 06/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201843703 | (05) | MO |
C50544 | (02) |