MEDICARE: WILLIAM R WANNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD-22826	IA
2	207RC0000X	Cardiovascular Disease Physician	1716	SD
3	207RC0000X	Cardiovascular Disease Physician	16952	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154395937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R WANNER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3128
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51102-3128
Country	:	US
Telephone Number	:	712-239-4702
Fax Number	:	712-224-5898

Provider Business Practice Location Address
First Line	:	5885 SUNNYBROOK DR
Second Line	:	SUITE L-200
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4203
Country	:	US
Telephone Number	:	712-239-4702
Fax Number	:	712-224-5898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	10/15/2015

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Directions to “ WILLIAM R WANNER M.D.” Practice Location

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