Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | Q7985 | TX |
NPI | 1326488123 |
---|---|
Provider Name | Dr. Marcel Wiley |
First Address | Tomball, TX 77375-6410 |
Second Address | Tomball, TX 77375-6410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 03/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1R6331 | MEDICARE (01) | TX |