=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316987910
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD E WENDT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 01/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11107 HILAIRE BLAISE DR
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-335-7755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2029 VALLEY ANESTHESIA ASSOCIATES
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93303-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-335-7755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | A22604
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------