Provider Demographics
NPI:1790367027
Name:NATHANIEL WOLKENFELD LLC
Entity Type:Organization
Organization Name:NATHANIEL WOLKENFELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLKENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-255-4800
Mailing Address - Street 1:7255 BARKSDALE LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8627
Mailing Address - Country:US
Mailing Address - Phone:520-255-4800
Mailing Address - Fax:
Practice Address - Street 1:540 W 5TH ST STE 470
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5070
Practice Address - Country:US
Practice Address - Phone:432-580-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty