Healthcare Provider Details

I. General information

NPI: 1326482977
Provider Name (Legal Business Name): DARREN WREDE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 09/14/2021
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12416 66TH ST STE D
LARGO FL
33773-3430
US

IV. Provider business mailing address

7751 ARALIA WAY
SEMINOLE FL
33777-4911
US

V. Phone/Fax

Practice location:
  • Phone: 727-408-5310
  • Fax:
Mailing address:
  • Phone: 816-820-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2017009383
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS14567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: