Healthcare Provider Details

I. General information

NPI: 1275508855
Provider Name (Legal Business Name): JEROME AMBROSE WEHR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W GANDY BLVD
TAMPA FL
33611-2931
US

IV. Provider business mailing address

3301 W GANDY BLVD
TAMPA FL
33611
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-1903
  • Fax: 813-749-8370
Mailing address:
  • Phone: 813-925-1903
  • Fax: 813-749-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21600
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME127069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: