MEDICARE: MR. JOHN LEE WAMBLE JR. 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
1	2084P0800X	Psychiatry Physician	H6976	TX
2	2084P0800X	Psychiatry Physician	06039	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922120740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN LEE WAMBLE JR. MD

Provider Business Mailing Address
First Line	:	1600 JAMES BOWIE
Second Line	:	SUITE D103
City	:	BAYTOWN
State	:	TX
Zip	:	77520-3340
Country	:	US
Telephone Number	:	281-428-1870
Fax Number	:	281-422-0658

Provider Business Practice Location Address
First Line	:	1600 JAMES BOWIE
Second Line	:	SUITE D103
City	:	BAYTOWN
State	:	TX
Zip	:	77520-3340
Country	:	US
Telephone Number	:	281-428-1870
Fax Number	:	281-422-0658

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/19/2010

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