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General NPI Number Information
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NPI Number | 1225123797
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Entity Type | Individual
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Provider Name | DEBORAH WENKERT M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3660 VISTA AVE
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City | ST. LOUIS
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State | MO
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Zip | 63110
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Country | US
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Telephone | 314-977-6195
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Fax | 314-977-8818
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Provider Business Mailing Address
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Address Line | 3691 RUTGER ST. PROVIDER ENROLLMENT
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City | ST. LOUIS
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State | MO
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Zip | 63110
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Country | US
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Telephone | 314-977-6828
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Fax | 314-977-6777
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 108299
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License Number State | MO
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