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NPI Code Detail

MEDICARE: PAUL H WURST MD

MEDICARE: PAUL H WURST MD
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
12084P0800XPsychiatry PhysicianME55057FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
118041OTHERFLBCBS OF FL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366448615
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL H WURST MD
Provider Business Mailing Address
First Line : 4408 DELWOOD LN
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32408-7492
Country : US
Telephone Number : 850-636-7000
Fax Number : 850-636-7072
Provider Business Practice Location Address
First Line : 525 E 15TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-5412
Country : US
Telephone Number : 850-522-4485
Fax Number : 850-914-6281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 01/29/2015

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Directions to “ PAUL H WURST MD” Practice Location

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