Basic Information
| Provider Information | |||||||||
| NPI: | 1538279633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WANDERMAN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | MERRITT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD FAAOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1485 N TURQUOISE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860011398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287747757 | ||||||||
| FaxNumber: | 9287747767 | ||||||||
| Practice Location | |||||||||
| Address1: | 1146 W HWY 89A | ||||||||
| Address2: | SUITE C3 | ||||||||
| City: | SEDONA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863365768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287747757 | ||||||||
| FaxNumber: | 9287747767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 01/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 036312 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 174400000X | 42698 | AZ | Y | Other Service Providers | Specialist |
No ID Information.