MEDICARE: JEFFREY STUART WENGER 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	207RG0100X	Gastroenterology Physician	ME58377	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801898655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY STUART WENGER M.D.

Provider Business Mailing Address
First Line	:	1117 N OLIVE AVE
Second Line	:	STE. 203
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3520
Country	:	US
Telephone Number	:	561-802-9050
Fax Number	:	561-802-9059

Provider Business Practice Location Address
First Line	:	1117 N OLIVE AVE
Second Line	:	STE. 203
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3520
Country	:	US
Telephone Number	:	561-802-9050
Fax Number	:	561-802-9059

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/19/2012

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