Individual
GAVIN NEAL WAGENHEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6431 FANNIN ST, SUITE 6.018, HOUSTON, TX 77030-1501
(713) 500-7391
Mailing address
250 BLOSSOM ST, STE 220, WEBSTER, TX 77598-4243
(713) 500-7391
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
Q7979
TX
Other
Enumeration date
09/17/2012
Last updated
09/25/2024
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