Individual
SEAN DARYL WENGROFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
540 W 15TH ST, HEREFORD, TX 79045
(806) 364-7512
(806) 349-5652
Mailing address
540 W 15TH ST, HEREFORD, TX 79045-2820
(806) 364-7512
(806) 349-5652
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
L4167
TX
208M00000X
Hospitalist Physician
L4167
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163758901
—
TX
01
—
8K4080
BCBS
TX
Enumeration date
04/11/2006
Last updated
09/12/2018
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