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Individual

JOSEPH M. WENTZELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1934 EMERALD WAY, LYNDEN, WA 98264-9734
(360) 320-8579
Mailing address
1934 EMERALD WAY, LYNDEN, WA 98264-9734
(360) 320-8579

Taxonomy

Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
0101268874
VA
207ND0101X
MOHS-Micrographic Surgery Physician
4270A
WY
207ND0101X
MOHS-Micrographic Surgery Physician
59833
AZ
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
60351927
WA
207ND0101X
MOHS-Micrographic Surgery Physician
6255
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000096270
BCBS PIN
WY
01
0011305
MDCD PIN
MT
01
100431000
MDCD PIN
WY
Enumeration date
01/03/2007
Last updated
05/18/2022
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