Provider Demographics
NPI:1790862522
Name:BIXENMAN, WAYNE W (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:W
Last Name:BIXENMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1500 N WILMOT RD
Mailing Address - Street 2:SUITE 180C
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-886-4137
Mailing Address - Fax:520-886-5605
Practice Address - Street 1:6422 E SPEEDWAY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1151
Practice Address - Country:US
Practice Address - Phone:520-327-3487
Practice Address - Fax:520-886-5605
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ11672207WX0109X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E00246Medicare UPIN