Healthcare Provider Details

I. General information

NPI: 1073631404
Provider Name (Legal Business Name): WEST TEXAS ALLERGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRIARWOOD AVE STE 100
MIDLAND TX
79707-2753
US

IV. Provider business mailing address

5000 BRIARWOOD AVE
MIDLAND TX
79707-2753
US

V. Phone/Fax

Practice location:
  • Phone: 432-682-5385
  • Fax: 432-682-1265
Mailing address:
  • Phone: 432-682-5385
  • Fax: 432-682-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL P WOLBERT
Title or Position: OWNER
Credential: MD
Phone: 432-682-5385