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NPI Code Detail

MEDICARE: DR. WAYNE JAMES VON BARGEN PH.D.

MEDICARE: DR. WAYNE JAMES VON BARGEN PH.D.
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
1103TC0700XClinical Psychologist20010203AIN

General Provider Information

NPI Number : 1376593046
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WAYNE JAMES VON BARGEN PH.D.
Provider Business Mailing Address
First Line : 1910 SAINT JOE CENTER RD
Second Line : SUITE 44
City : FORT WAYNE
State : IN
Zip : 46825-5000
Country : US
Telephone Number : 260-471-8033
Fax Number : 260-471-8107
Provider Business Practice Location Address
First Line : 1910 SAINT JOE CENTER RD
Second Line : SUITE 44
City : FORT WAYNE
State : IN
Zip : 46825-5000
Country : US
Telephone Number : 260-471-8033
Fax Number : 260-471-8107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 07/08/2007

Similar Medicare Providers

1366492043 — VON BARGEN ASSOCIATES, INC.
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