Provider Demographics
NPI:1659477222
Name:MARKOWITZ, WENDY S (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:MARKOWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:S
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1009 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4768
Mailing Address - Country:US
Mailing Address - Phone:903-212-4330
Mailing Address - Fax:903-212-4333
Practice Address - Street 1:1009 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4768
Practice Address - Country:US
Practice Address - Phone:903-212-4330
Practice Address - Fax:903-212-4333
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282086201Medicaid
TXTXB125565Medicare UPIN
TX282086201Medicaid