Healthcare Provider Details

I. General information

NPI: 1649368960
Provider Name (Legal Business Name): GARY NEIL WURGLER PHYSICIANS ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47226 S RHONDA AVE
SIOUX FALLS SD
57108
US

IV. Provider business mailing address

47226 S RHONDA AVE
SIOUX FALLS SD
57108-8116
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-3230
  • Fax:
Mailing address:
  • Phone: 605-336-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0126
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: