Provider Demographics
NPI:1538338314
Name:RALPH J WENTZ DPM PC
Entity type:Organization
Organization Name:RALPH J WENTZ DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WENTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-539-6600
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-0456
Mailing Address - Country:US
Mailing Address - Phone:719-539-6600
Mailing Address - Fax:719-539-6606
Practice Address - Street 1:920 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9669
Practice Address - Country:US
Practice Address - Phone:719-539-6600
Practice Address - Fax:719-539-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1045130002Medicare NSC