Individual
DR. RICHARD G WANDERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4646 POPLAR AVE STE 302, MEMPHIS, TN 38117-4433
(901) 930-7397
(905) 552-3902
Mailing address
4646 POPLAR AVE STE 302, MEMPHIS, TN 38117-4433
(901) 930-7397
(901) 552-3902
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
22468
TN
207Q00000X
Family Medicine Physician
22468
TN
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
22468
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3194814
—
TN
Enumeration date
09/25/2006
Last updated
10/19/2022
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