Provider Demographics
NPI:1912016163
Name:WENZL, DANIEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:WENZL
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 1:203 AVALON AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2855
Mailing Address - Country:US
Mailing Address - Phone:256-386-1110
Mailing Address - Fax:256-386-1114
Practice Address - Street 1:203 AVALON AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2855
Practice Address - Country:US
Practice Address - Phone:256-386-1110
Practice Address - Fax:256-386-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012269207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000014931Medicaid
PA0000060830OtherBLUE CROSS BLUE SHIELD
TN0051047OtherBLUE CROSS BLUE SHIELD
000014931Medicare ID - Type Unspecified
AL000014931Medicaid