Healthcare Provider Details

I. General information

NPI: 1215517677
Provider Name (Legal Business Name): JEFFREY WURTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N KROME AVE STE 401
HOMESTEAD FL
33030-4443
US

IV. Provider business mailing address

950 N KROME AVE STE 401
HOMESTEAD FL
33030-4443
US

V. Phone/Fax

Practice location:
  • Phone: 305-248-0874
  • Fax:
Mailing address:
  • Phone: 305-248-0874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME168341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: