Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0399 | MD |
Y | 222Z00000X | Podiatrist | 0399 | MD |
NPI | 1033211891 |
---|---|
Provider Name | Dr. Bruce Allan Wenzel |
First Address | Waldorf, MD 20602-3223 |
Second Address | Waldorf, MD 20602-3223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T73283 | (02) | MD |