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General NPI Number Information
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NPI Number | 1043430747
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Entity Type | Organization
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Legal Business Name | KARL C WENNER MD PC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2200 BRYANT WILLIAMS DR SUITE 1
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1120
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Country | US
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Telephone | 541-884-7746
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Fax | 541-884-0848
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Provider Business Mailing Address
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Address Line | 2200 BRYANT WILLIAMS DR SUITE 1
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-1120
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Country | US
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Telephone | 541-884-7746
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Fax | 541-884-0848
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JEANNETTE L GANSBERG
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Credential |
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Telephone | 541-274-2902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD15968
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License Number State | OR
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