Provider Demographics
NPI:1801902135
Name:RANKIN, WENDELL DALE (DO)
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:DALE
Last Name:RANKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3126 S JACKSON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2534
Mailing Address - Country:US
Mailing Address - Phone:417-781-1600
Mailing Address - Fax:417-627-8725
Practice Address - Street 1:3126 S JACKSON AVE
Practice Address - Street 2:STE 200
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2534
Practice Address - Country:US
Practice Address - Phone:417-781-1600
Practice Address - Fax:417-627-8725
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO32289207R00000X
ARR4696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1801902135Medicaid
OK200073100AMedicaid
AR5N730Medicare PIN
MO1801902135Medicaid
MOA10709Medicare UPIN