MEDICARE: ANNA M WIDMYER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MT194596	PA
2	208600000X	Surgery Physician	MD452141	PA
3	208200000X	Plastic Surgery Physician	ME134153	FL

General Provider Information

NPI Number	:	1346477163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA M WIDMYER M.D.

Provider Business Mailing Address
First Line	:	6274 LAKE OSPREY DR
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-8425
Country	:	US
Telephone Number	:	941-500-3350
Fax Number	:

Provider Business Practice Location Address
First Line	:	6274 LAKE OSPREY DR
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-8425
Country	:	US
Telephone Number	:	941-500-3350
Fax Number	:	941-220-4338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	07/11/2024

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