Northam, Wanda M

Northam, Wanda M is an individual health care provider with primary practice located at 4800 Texas Blvd Ste 100 , Texarkana TX 75503-3033. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Northam, Wanda M can be contacted via phone (318) 222-8421.

Contact Information

Primary practice address
4800 Texas Blvd Ste 100 Texarkana TX 75503-3033
Fax: (318) 673-9972
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X J0619 Texas

Profile Details

NPI number 1780684183
LBN Legal business name Northam, Wanda M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2005
Last updated Dec 31st, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780684183 NPPES
Arkansas MEDICAID 119308001
Arkansas MEDICAID 047789501

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