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General NPI Number Information
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NPI Number | 1891758462
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Entity Type | Organization
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Legal Business Name | SEAN D WENGROFF, MD
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 6409 MEMORIAL DR
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City | TEXAS CITY
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State | TX
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Zip | 77591-4017
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Country | US
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Telephone | 409-935-5926
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Fax | 409-935-5840
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Provider Business Mailing Address
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Address Line | PO BOX 293869
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City | KERRVILLE
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State | TX
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Zip | 78029-3869
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Country | US
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Telephone | 409-935-5926
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Fax | 409-935-5840
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Authorized Official
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Title or Position | OWNER
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Name | SEAN D WENGROFF
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Credential | MD
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Telephone | 409-935-5926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | L4167
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License Number State | TX
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