Provider Demographics
NPI:1669557849
Name:WENDEL, BRENT ROBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ROBERT
Last Name:WENDEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 NW HIGH LAKES LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-6973
Mailing Address - Country:US
Mailing Address - Phone:206-250-4320
Mailing Address - Fax:
Practice Address - Street 1:900 NW MT WASHINGTON DR STE 205
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-6719
Practice Address - Country:US
Practice Address - Phone:541-246-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP214271213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101063OtherLABOR AND INDUSTRY
WA1106616Medicaid
U72242Medicare UPIN
WA101063OtherLABOR AND INDUSTRY
WAAB14116Medicare PIN