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Individual

DR. PAUL DOUGLAS WENTLAND

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1508 TOMBRAS AVE, EAST RIDGE, TN 37412-2720
(423) 867-4969
(423) 867-4971
Mailing address
1508 TOMBRAS AVE, EAST RIDGE, TN 37412-2720
(423) 867-4969
(423) 867-4971

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
40539
TN
207R00000X
Internal Medicine Physician
74929
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003171303A
GA
01
5462860
BCBS OF TENNESSEE
TN
05
Q018129
TN
Enumeration date
02/05/2008
Last updated
04/08/2016
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