Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01051725A | IN |
Y | 207Q00000X | Family Doctor | C10002773 | DE |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 01051725A | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | C10002773 | DE |
NPI | 1336170083 |
---|---|
Provider Name | Dr. Wayne Cruz Zwick |
First Address | Milford, DE 19963-4168 |
Second Address | Milford, DE 19963-5395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 13/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E78609 | (02) |