Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME 69134 | FL |
NPI | 1407824568 |
---|---|
Provider Name | Wendell N. Colberg |
First Address | Pensacola, FL 32507-0400 |
Second Address | Pensacola, FL 32512-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/07/2007 |