Individual
MR. TRACEY G WELLENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
405 S CLARK ST, SUITE 215, CARROLL, IA 51401-3065
(712) 792-4368
(712) 792-2056
Mailing address
PO BOX 766, CARROLL, IA 51401-0766
(712) 792-4368
(712) 792-4351
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
30594
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124032
—
IA
05
—
2124032
—
IA
05
—
3124032
—
IA
05
—
5124032
—
IA
05
—
6124032
—
IA
Enumeration date
10/14/2005
Last updated
03/25/2019
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