Individual
DOUGLASS JOHN WACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Contact information
Practice address
3900 LA BRANCH ST, HOUSTON, TX 77004-4046
(713) 524-3949
(713) 524-3915
Mailing address
3900 LA BRANCH ST, HOUSTON, TX 77004-4046
(713) 524-3949
(713) 524-3915
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
85
TX
224P00000X
Prosthetist
Primary
85
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PO0012
—
TX
Enumeration date
03/31/2009
Last updated
11/30/2016
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