Healthcare Provider Details

I. General information

NPI: 1477516458
Provider Name (Legal Business Name): GWEN R WURM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST
MIAMI FL
33136-2137
US

IV. Provider business mailing address

1475 NW 12TH AVE BOX 016960 M851
MIAMI FL
33136-1002
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-5050
  • Fax: 305-270-3846
Mailing address:
  • Phone: 305-243-7249
  • Fax: 305-243-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME48698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: