Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 9237 | AZ |
NPI | 1114904109 |
---|---|
Provider Name | Dr. Albert Guy Wendt |
First Address | Phoenix, AZ 85012-2716 |
Second Address | Phoenix, AZ 85004-2155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D00547 | (02) | AZ |