Provider Demographics
NPI:1215018569
Name:WUEST, WILMER LEO (MD)
Entity Type:Individual
Prefix:
First Name:WILMER
Middle Name:LEO
Last Name:WUEST
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 1:333 N RIVERSHIRE DR STE 240
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2711
Mailing Address - Country:US
Mailing Address - Phone:936-756-8853
Mailing Address - Fax:936-756-7069
Practice Address - Street 1:333 N RIVERSHIRE DR STE 240
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2711
Practice Address - Country:US
Practice Address - Phone:936-756-8853
Practice Address - Fax:936-756-7069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist