Provider Demographics
NPI:1063453827
Name:WENTHE, MARTIN T (MD)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:T
Last Name:WENTHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 W HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8402
Mailing Address - Country:US
Mailing Address - Phone:559-271-6365
Mailing Address - Fax:559-271-6326
Practice Address - Street 1:4770 W HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8402
Practice Address - Country:US
Practice Address - Phone:559-271-6365
Practice Address - Fax:559-271-6326
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080184350OtherMEDICARE RR
CA00A784600Medicaid
CA00A784600Medicaid
AY812Medicare UPIN
080184350OtherMEDICARE RR