Healthcare Provider Details

I. General information

NPI: 1184812315
Provider Name (Legal Business Name): ROBERT P WUNDERLICH DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N MAIN AVE #201
SAN ANTONIO TX
78212-4740
US

IV. Provider business mailing address

PO BOX 12092
SAN ANTONIO TX
78212-0092
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-9200
  • Fax: 210-281-9734
Mailing address:
  • Phone: 210-281-9200
  • Fax: 210-281-9734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1395
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT PETER WUNDERLICH
Title or Position: OWNER
Credential: D.P.M.
Phone: 210-281-9200