Individual
DERRICK WANSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1320 WONDER WORLD DR STE 106, SAN MARCOS, TX 78666-7558
(512) 851-1165
(833) 925-2433
Mailing address
1320 WONDER WORLD DR STE 106, SAN MARCOS, TX 78666-7558
(512) 851-1165
(512) 485-7224
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
Q9077
TX
208VP0014X
Interventional Pain Medicine Physician
Q9077
TX
Other
Enumeration date
07/31/2011
Last updated
11/21/2022
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