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General NPI Number Information
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NPI Number | 1770664732
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Entity Type | Individual
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Provider Name | MARTIN JEROME WIESENTHAL MD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/14/2017
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Provider Practice Location Address
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Address Line | 8038 WURZBACH RD SUITE 320
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3817
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Country | US
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Telephone | 210-614-3365
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Fax | 210-615-3757
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Provider Business Mailing Address
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Address Line | 8038 WURZBACH RD STE 320
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3813
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Country | US
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Telephone | 210-614-3365
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Fax | 210-615-3757
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E4763
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License Number State | TX
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