Healthcare Provider Details

I. General information

NPI: 1942395215
Provider Name (Legal Business Name): JAMES H WUDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 36TH ST
VERO BEACH FL
32960-4862
US

IV. Provider business mailing address

1000 36TH ST
VERO BEACH FL
32960-4862
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-4311
  • Fax:
Mailing address:
  • Phone: 772-567-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number20490
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number20490
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number12243
License Number StateSD
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME147149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: