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NPI Code Detail

MEDICARE: DR. DETLEF WENCKER MD

MEDICARE: DR. DETLEF WENCKER MD
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
1207RC0000XCardiovascular Disease Physician04-36793KS
2207RA0001XAdvanced Heart Failure and Transplant Cardiology PhysicianR4343TX
3207RC0000XCardiovascular Disease PhysicianD00000MD

General Provider Information

NPI Number : 1285634881
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DETLEF WENCKER MD
Provider Business Mailing Address
First Line : 1000 S BECKHAM AVE
Second Line :
City : TYLER
State : TX
Zip : 75701-1908
Country : US
Telephone Number : 903-595-5514
Fax Number : 903-262-3715
Provider Business Practice Location Address
First Line : 1000 S BECKHAM AVE
Second Line :
City : TYLER
State : TX
Zip : 75701-1908
Country : US
Telephone Number : 903-595-5514
Fax Number : 903-262-3715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 09/25/2025

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Directions to “ DR. DETLEF WENCKER MD” Practice Location

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