Healthcare Provider Details

I. General information

NPI: 1366673568
Provider Name (Legal Business Name): DESMOND JY WAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DESMOND WAH MD

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

PO BOX 236
BATESVILLE IN
47006-0236
US

V. Phone/Fax

Practice location:
  • Phone: 812-934-6624
  • Fax:
Mailing address:
  • Phone: 812-933-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01073560A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: