Provider Demographics
NPI:1790903359
Name:WANDREY, DANIEL ENOCH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ENOCH
Last Name:WANDREY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2504 RIDGE RD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2569
Mailing Address - Country:US
Mailing Address - Phone:469-267-6814
Mailing Address - Fax:972-722-4816
Practice Address - Street 1:2504 RIDGE RD
Practice Address - Street 2:SUITE #202
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2569
Practice Address - Country:US
Practice Address - Phone:469-267-6814
Practice Address - Fax:972-722-4816
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2018-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN9327208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340494903Medicaid
TX340494904Medicaid