MEDICARE: MARK A. WEHRY 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
1	2088P0231X	Pediatric Urology Physician	ME73290	FL
2	208800000X	Urology Physician	ME73290	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	:	1841350659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A. WEHRY MD

Provider Business Mailing Address
First Line	:	PO BOX 2699
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32513-2699
Country	:	US
Telephone Number	:	850-475-4686
Fax Number	:	850-475-4619

Provider Business Practice Location Address
First Line	:	23 MACK BAYOU LOOP STE 100
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-2606
Country	:	US
Telephone Number	:	850-416-1575
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	04/09/2018

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Directions to “ MARK A. WEHRY MD” Practice Location

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