Healthcare Provider Details

I. General information

NPI: 1962758938
Provider Name (Legal Business Name): JACEK ROBERT WECOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SE MAGNOLIA EXT STE 205
OCALA FL
34471-4461
US

IV. Provider business mailing address

2405 SE 17TH ST STE 201
OCALA FL
34471-9190
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-1800
  • Fax: 352-629-1888
Mailing address:
  • Phone: 352-690-2171
  • Fax: 352-690-6954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberHSE26199
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number50398
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME141977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: