# GERIATRIC PM&R LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992188403
- **Authorized official:** CATHERINE WAKEHAM MD (OWNER)
- **Authorized official phone:** (915) 209-0589

## Contact information

- **Practice address:** 329 VISTA DEL REY DR, EL PASO, TX 79912-4824
- **Practice address phone:** (915) 209-0157
- **Mailing address:** PO BOX 700390, DEPT 0471, TULSA, OK 74170-0390
- **Mailing address phone:** (254) 727-9193

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/01/2015
- **Last updated:** 11/25/2019