Healthcare Provider Details

I. General information

NPI: 1043030232
Provider Name (Legal Business Name): BRENT R. WENDEL, DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW MT WASHINGTON DR STE 205
BEND OR
97703-6719
US

IV. Provider business mailing address

2221 NW HIGH LAKES LOOP
BEND OR
97703-6973
US

V. Phone/Fax

Practice location:
  • Phone: 541-246-3577
  • Fax:
Mailing address:
  • Phone: 206-250-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT ROBERT WENDEL
Title or Position: OWNER
Credential: DPM
Phone: 206-250-4320