MEDICARE: DR. SCOTT JAMES WENGER D.O.

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	208600000X	Surgery Physician	20A10859	CA
2	208600000X	Surgery Physician	34010762	OH

General Provider Information

NPI Number	:	1780659276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT JAMES WENGER D.O.

Provider Business Mailing Address
First Line	:	5893 COPLEY DR
Second Line	:	4TH FLOOR GENERAL SURGERY DEPARTMENT
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7906
Country	:	US
Telephone Number	:	858-616-5011
Fax Number	:	858-616-5040

Provider Business Practice Location Address
First Line	:	5893 COPLEY DR
Second Line	:	4TH FLOOR GENERAL SURGERY DEPARTMENT
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7906
Country	:	US
Telephone Number	:	858-616-5011
Fax Number	:	858-616-5040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	11/18/2021

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