Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD49512 | TN |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD49512 | TN |
NPI | 1134151129 |
---|---|
Provider Name | Dr. Richard Joseph Wendorf |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2757440 | (05) | OH |