Individual
DR. GORDON EDGAR WUEBBOLT
Active
Individual
DR. GORDON EDGAR WUEBBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
219642-1
NY
156FX1100X
Ophthalmic Technician/Technologist
MD052930L
PA
207W00000X
Ophthalmology Physician
219642-1
NY
207W00000X
Ophthalmology Physician
Primary
MD052930L
PA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
219642-1
NY
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
MD052930L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001464588
—
PA
05
—
02155728
—
NY
Enumeration date
02/17/2006
Last updated
10/13/2021
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