Provider Demographics
NPI:1538279633
Name:WANDERMAN, STEVEN MERRITT (MD FAAOS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MERRITT
Last Name:WANDERMAN
Suffix:
Gender:M
Credentials:MD FAAOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 N TURQUOISE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1398
Mailing Address - Country:US
Mailing Address - Phone:928-774-7757
Mailing Address - Fax:928-774-7767
Practice Address - Street 1:1146 W HWY 89A
Practice Address - Street 2:SUITE C3
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5768
Practice Address - Country:US
Practice Address - Phone:928-774-7757
Practice Address - Fax:928-774-7767
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036312207X00000X
AZ42698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E51682Medicare UPIN
20BDCDRMedicare ID - Type Unspecified