Healthcare Provider Details

I. General information

NPI: 1144160490
Provider Name (Legal Business Name): COREMD SPINE AND JOINTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31201 US HIGHWAY 19 N STE 3
PALM HARBOR FL
34684-4422
US

IV. Provider business mailing address

4923 AUGUSTA AVE
OLDSMAR FL
34677-6332
US

V. Phone/Fax

Practice location:
  • Phone: 813-368-9298
  • Fax: 727-263-1057
Mailing address:
  • Phone: 813-368-9298
  • Fax: 727-263-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WESSAM GERGUIS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 813-368-9298