Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | H6699 | TX |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | H6699 | TX |
NPI | 1114089372 |
---|---|
Provider Name | Tony Soo-Tong Wen |
First Address | Galveston, TX 77555-1022 |
Second Address | Galveston, TX 77555-1022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 28/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138845614 | (05) | TX |
F33851 | (02) | TX |