Healthcare Provider Details

I. General information

NPI: 1952334682
Provider Name (Legal Business Name): ERIC ALAN WURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 STONEVIEW RD
ORLANDO FL
32806-5077
US

IV. Provider business mailing address

2517 STONEVIEW RD
ORLANDO FL
32806-5077
US

V. Phone/Fax

Practice location:
  • Phone: 407-754-5545
  • Fax:
Mailing address:
  • Phone: 407-754-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME75840
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME75840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: