Provider Demographics
NPI:1598757239
Name:LETIZIA, WAYNE LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:LAWRENCE
Last Name:LETIZIA
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 1:10010 E TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-2160
Mailing Address - Country:US
Mailing Address - Phone:816-252-7800
Mailing Address - Fax:816-252-3542
Practice Address - Street 1:10010 E TRUMAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-2160
Practice Address - Country:US
Practice Address - Phone:816-252-7800
Practice Address - Fax:816-252-3542
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9A63207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50406Medicare UPIN
H334509Medicare ID - Type Unspecified