Provider Demographics
NPI:1043030232
Name:BRENT R. WENDEL, DPM, LLC
Entity type:Organization
Organization Name:BRENT R. WENDEL, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-250-4320
Mailing Address - Street 1:2221 NW HIGH LAKES LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-6973
Mailing Address - Country:US
Mailing Address - Phone:206-250-4320
Mailing Address - Fax:
Practice Address - Street 1:900 NW MT WASHINGTON DR STE 205
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-6719
Practice Address - Country:US
Practice Address - Phone:541-246-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty