Doctor Name: | DR. RALPH MERRILL WETZEL |
NPI Number: | 1063525616 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.DIV, S.T.M, D.MIN. |
License Number: | |
Business Practice Address: | 2121 Lake Ave 125-f Fort Wayne, IN - 468055100 |
Business Phone Number: | 2604265431 |
Business Fax Number: | 2604601402 |
Mailing Address: | 4310 Ara Dr, P.o. Box 286 WOODBURN |
State: | IN |
Postal Code: | 467979588 |
Phone Number: | 2604933695 |
Fax Number: | 2604933322 |
NPI Enumeration Date: | 08/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |