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General NPI Number Information
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NPI Number | 1598107641
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Entity Type | Organization
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Legal Business Name | D. E. WENNER III, M.D., P.C.
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 1600 SE MAIN ST SUITE F
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City | ROSWELL
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State | NM
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Zip | 88203-5423
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Country | US
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Telephone | 575-623-1980
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 SE MAIN ST SUITE F
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City | ROSWELL
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State | NM
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Zip | 88203-5423
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Country | US
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Telephone | 575-623-1980
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. DONALD E WENNER III
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Credential | M.D.
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Telephone | 15756231980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD2012-0816
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License Number State | NM
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