Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | 35080347W | OH |
Y | 2080P0205X | Pediatric Endocrinologist | A62927 | CA |
NPI | 1457341497 |
---|---|
Provider Name | Lawrence Allen Wetterau |
First Address | Madera, CA 93636-8761 |
Second Address | Madera, CA 93636-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A629270 | MEDICAL RENDERING NUMBER (01) | CA |
2282284 | (05) | OH |
64060635 | (05) | KY |
H52589 | (02) |