Healthcare Provider Details

I. General information

NPI: 1629170519
Provider Name (Legal Business Name): DAVID MORRIS WIMBERLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 GEMINI ST STE 128
HOUSTON TX
77058-2746
US

IV. Provider business mailing address

1002 GEMINI ST STE 128
HOUSTON TX
77058-2746
US

V. Phone/Fax

Practice location:
  • Phone: 281-218-9515
  • Fax: 281-218-9534
Mailing address:
  • Phone: 281-218-9515
  • Fax: 281-218-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH5279
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH5279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: