Provider Demographics
NPI:1467686444
Name:WAKEHAM, CATHERINE DAVENPORTPOLLOCK (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DAVENPORTPOLLOCK
Last Name:WAKEHAM
Suffix:
Gender:F
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:PO BOX 700390, DEPT 0471
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-0390
Mailing Address - Country:US
Mailing Address - Phone:254-727-9193
Mailing Address - Fax:
Practice Address - Street 1:329 VISTA DEL REY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4824
Practice Address - Country:US
Practice Address - Phone:915-259-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6746207RG0300X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine