Provider Demographics
NPI:1902076003
Name:DAVID WREN, JR., M.D., INC
Entity Type:Organization
Organization Name:DAVID WREN, JR., M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:510-235-9014
Mailing Address - Street 1:120 BROADWAY
Mailing Address - Street 2:SUITE 21
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-1938
Mailing Address - Country:US
Mailing Address - Phone:510-235-9014
Mailing Address - Fax:510-232-1411
Practice Address - Street 1:120 BROADWAY
Practice Address - Street 2:SUITE 21
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1938
Practice Address - Country:US
Practice Address - Phone:510-235-9014
Practice Address - Fax:510-232-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41731Medicare UPIN
CA00G228101Medicare PIN