Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MT184053 | PA |
N | 208600000X | Surgeon | MT184053 | PA |
N | 208200000X | Surgeon | P6546 | TX |
N | 208600000X | Surgeon | P6546 | TX |
N | 2082S0105X | Plastic Hand Surgeon | P6546 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | P6546 | TX |
NPI | 1619030418 |
---|---|
Provider Name | Galen Samuel Wachtman |
First Address | Austin, TX 78705-3548 |
Second Address | Austin, TX 78705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 13/01/2021 |