Provider Demographics
NPI:1578693297
Name:GIDEON, WENDY L (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:GIDEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12274 BANDERA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4385
Mailing Address - Country:US
Mailing Address - Phone:210-372-0505
Mailing Address - Fax:210-372-0404
Practice Address - Street 1:12274 BANDERA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4385
Practice Address - Country:US
Practice Address - Phone:210-372-0505
Practice Address - Fax:210-372-0404
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K2131OtherINDIV BCBS PROV#
TXH67834Medicare UPIN