Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | D31295 | MD |
NPI | 1174577522 |
---|---|
Provider Name | Dr. Wendy D Kloesz |
First Address | Beaufort, SC 29907-1164 |
Second Address | Beaufort, SC 29907-1164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 18/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D29946 | (02) |