Healthcare Provider Details

I. General information

NPI: 1669557849
Provider Name (Legal Business Name): BRENT ROBERT WENDEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
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 NumberDP214271
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: