Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | J0357 | TX |
NPI | 1003917881 |
---|---|
Provider Name | David Walter Wenzel |
First Address | San Antonio, TX 78258-4278 |
Second Address | San Antonio, TX 78258-4278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F35838 | (02) | TX |