Provider Demographics
NPI:1336436369
Name:GEORGE M WAHBA MD INC
Entity type:Organization
Organization Name:GEORGE M WAHBA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAHBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-324-0300
Mailing Address - Street 1:PO BOX 2323
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2323
Mailing Address - Country:US
Mailing Address - Phone:661-324-0300
Mailing Address - Fax:661-324-4095
Practice Address - Street 1:400 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9781
Practice Address - Country:US
Practice Address - Phone:661-663-6550
Practice Address - Fax:661-663-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97606207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty