Provider Demographics
NPI:1972500866
Name:FIELDER, WENDELL DREW (MD)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:DREW
Last Name:FIELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WENDELL
Other - Middle Name:DREW
Other - Last Name:FIELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1601 TRINITY ST STE 704F
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1765
Mailing Address - Country:US
Mailing Address - Phone:512-324-7873
Mailing Address - Fax:512-380-7503
Practice Address - Street 1:1601 TRINITY ST STE 704F
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1765
Practice Address - Country:US
Practice Address - Phone:512-324-7873
Practice Address - Fax:512-380-7503
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2001208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137659212Medicaid
G03773Medicare UPIN
TX137659212Medicaid
TX8L20700Medicare PIN