Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 39312 | TN |
N | 2080P0202X | Pediatric Cardiologist | 39312 | TN |
NPI | 1023074010 |
---|---|
Provider Name | Glenn T Wetzel |
First Address | Memphis, TN 38103-2802 |
Second Address | Memphis, TN 38103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 13/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3325777 | (05) | TN |
E32622 | (02) |