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General NPI Number Information
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NPI Number | 1326044751
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Entity Type | Individual
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Provider Name | GEORGE A VAN DE WYNGAERDE MD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 444 W OSBORN RD SUITE 200
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City | PHOENIX
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State | AZ
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Zip | 85013-3814
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Country | US
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Telephone | 602-230-1400
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Fax | 602-230-7676
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Provider Business Mailing Address
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Address Line | 444 W OSBORN RD SUITE 200
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City | PHOENIX
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State | AZ
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Zip | 85013-3814
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Country | US
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Telephone | 602-230-1400
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Fax | 602-230-7676
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 6074
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License Number State | AZ
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