Healthcare Provider Details

I. General information

NPI: 1487606547
Provider Name (Legal Business Name): KENNETH WETCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13024 VALEWOOD DR
NAPLES FL
34119-8577
US

IV. Provider business mailing address

13024 VALEWOOD DR
NAPLES FL
34119-8577
US

V. Phone/Fax

Practice location:
  • Phone: 970-331-3310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD6691
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6772A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41044
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME92093
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23668
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: