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General NPI Number Information
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NPI Number | 1285634881
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Entity Type | Individual
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Provider Name | DETLEF WENCKER MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 1000 S BECKHAM AVE
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City | TYLER
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State | TX
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Zip | 75701-1908
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Country | US
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Telephone | 903-595-5514
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Fax | 903-262-3715
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Provider Business Mailing Address
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Address Line | 1000 S BECKHAM AVE
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City | TYLER
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State | TX
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Zip | 75701-1908
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Country | US
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Telephone | 903-595-5514
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Fax | 903-262-3715
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 04-36793
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | R4343
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | D00000
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License Number State | MD
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