Organization
GERIATRIC PM&R LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE WAKEHAM MD (OWNER)
(915) 209-0589
Entity
Organization
Contact information
Practice address
329 VISTA DEL REY DR, EL PASO, TX 79912-4824
(915) 209-0157
Mailing address
PO BOX 700390, DEPT 0471, TULSA, OK 74170-0390
(254) 727-9193
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
07/01/2015
Last updated
11/25/2019
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