Provider Demographics
NPI:1861463275
Name:WENDER, DONALD B (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:WENDER
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 1:230 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1733
Mailing Address - Country:US
Mailing Address - Phone:712-252-0088
Mailing Address - Fax:712-252-5271
Practice Address - Street 1:230 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1733
Practice Address - Country:US
Practice Address - Phone:712-252-0088
Practice Address - Fax:712-252-5271
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26404207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0039966Medicaid
IA509280006OtherMEDICARE PTAN
IA509280006OtherMEDICARE PTAN