MEDICARE: ROBERT P WUNDERLICH DPM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	1395	TX

General Provider Information

NPI Number	:	1184812315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT P WUNDERLICH DPM PA

Provider Business Mailing Address
First Line	:	PO BOX 12092
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-0092
Country	:	US
Telephone Number	:	210-281-9200
Fax Number	:	210-281-9734

Provider Business Practice Location Address
First Line	:	1123 N MAIN AVE
Second Line	:	#201
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4740
Country	:	US
Telephone Number	:	210-281-9200
Fax Number	:	210-281-9734

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT PETER WUNDERLICH
Credential	:	D.P.M.
Telephone Number	:	210-281-9200

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	11/16/2007

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