1972548139 NPI number — DR. FREDERICK CARL WENDT MD

Table of content: DR. FREDERICK CARL WENDT MD (NPI 1972548139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972548139 NPI number — DR. FREDERICK CARL WENDT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENDT
Provider First Name:
FREDERICK
Provider Middle Name:
CARL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972548139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21626
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33742-1626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-723-6714
Provider Business Mailing Address Fax Number:
850-969-2910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8333 NORTH DAVIS HWY
Provider Second Line Business Practice Location Address:
MEDICAL CENTER CLINIC/RADIOLOGY DEP
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-474-8688
Provider Business Practice Location Address Fax Number:
850-969-2910
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME82869 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 264142900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com