Healthcare Provider Details

I. General information

NPI: 1962535617
Provider Name (Legal Business Name): RALPH MICHAEL WURSTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 SHERWOOD WAY
SAN ANGELO TX
76901-5642
US

IV. Provider business mailing address

5730 SHERWOOD WAY
SAN ANGELO TX
76901-5642
US

V. Phone/Fax

Practice location:
  • Phone: 325-944-3851
  • Fax: 325-947-1626
Mailing address:
  • Phone: 325-944-3851
  • Fax: 325-947-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9894
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0S6853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: